The University of Missouri School of Medicine announced on Mar. 10 that holding blood thinners for too long before and after surgery may increase the risk of complications for patients undergoing free flap reconstruction, a common head and neck surgical technique.
This finding is important because many older adults take blood thinners to prevent clots that can lead to heart attacks or strokes. Surgeons often stop these medications before operations due to bleeding risks, but the new research suggests that delaying their resumption could harm recovery.
Researchers studied 470 patients who had free flap reconstruction surgeries. They found that about 17% experienced complications, regardless of whether they were taking blood thinners. The main issue was not the use of blood thinners themselves, but rather how long they were withheld around the time of surgery.
"We're looking at two competing risks: too much clotting or too much bleeding," said Megan Gillespie, the study's lead author. "We found that the timing of stopping and restarting blood thinners around surgery matters. When these medications were held longer, patients experienced more complications. Our goal is to better define that sweet spot for restarting blood thinners, so patients are protected from excessive bleeding and dangerous clotting alike."
Patrick Tassone, MD, associate professor at the Mizzou School of Medicine and head and neck surgeon at MU Health Care, said most patients waited an average of five days after surgery to resume their medication. "In my personal practice, I've become more confident with resuming blood thinners after about 48 hours," Tassone said. "I would not do this for patients who had a bleeding event. To be definitive about it would require more data and further research." He added, "Setting a standard on how to manage blood thinners during the operative period will help make more surgeries a success."
The study was published in The Laryngoscope by Gillespie; Tassone; medical student Dylan Hood; Alok Dwivedi, PhD; and Tabitha Galloway, MD.
