Arch Hand Microsurg.  2022 Sep;27(3):211-216. 10.12790/ahm.22.0027.

Comparison of the hepatotoxicity of low-molecular-weight versus unfractionated heparin for anticoagulation therapy after digital replantation

• Lee JW
• Cha JH
• You HJ
• Kim DW
• Lee TY

• KMID: 2532736
• DOI: http://doi.org/10.12790/ahm.22.0027

Abstract

Purpose
Unfractionated heparin (UFH) is more commonly used as an anticoagulant after digital replantation than low-molecular-weight heparin (LMWH). We compared the success and complication rates of these two anticoagulants, since only a few studies have made this comparison directly.
Methods
Forty-four patients who underwent digital replantation for complete or incomplete digital amputation in the past 7 years at a single institution were included. The patients were divided into LMWH and UFH groups according to the anticoagulant administered. The success rates for each group were obtained, and the postoperative serum aspartate aminotransferase (AST) and alanine transaminase (ALT) levels were analyzed to compare the complication rates.
Results
All patients, except one, had successful recovery of circulation after replantation, and the success rate did not show a statistically significant difference between the two groups. The statistical analysis showed that the proportion of patients with abnormal serum AST or ALT levels in the LMWH group was significantly lower than that in the UFH group.
Conclusion
Although there was no significant difference in the success rate between the two groups, the risk of hepatotoxicity was significantly lower in the LMWH group than in the UFH group. Considering the advantages of LMWH, its extensive use is highly recommended for anticoagulation therapy in patients after digital replantation.

Keyword

Low-molecular-weight heparin; Replantation; Unfractionated heparin; Hepatotoxicity; Complication

Figure

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  Fig. 1. A 41-year-old man presented with his right index finger completely amputated at the proximal phalanx level by an electrical saw (A). Replantation was performed immediately, and unfractionated heparin was administered intravenously after the operation. The patient showed elevated aspartate aminotransferase and alanine transaminase levels (220 U/L and 258 U/L, respectively), without any marked symptoms of hepatotoxicity. (B) The operation was successful with minimal sequelae.

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  Fig. 2. A 21-year-old man presented with complete amputation of his left thumb at the proximal phalanx and index at the mid-phalanx by an industrial cutter (A). Immediate replantation was performed, and the patient was administered low-molecular-weight heparin for perioperative anticoagulant therapy. The aspartate aminotransferase and alanine transaminase levels of this patient were normal during admission, without any evidence of hepatotoxicity. (B) Clinical photograph a year after surgery.

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  Fig. 3. The success rates showed no difference between the two groups. LMWH, low-molecular-weight heparin; UFH, unfractionated heparin.

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  Fig. 4. The complication rates showed significant differences between the two groups in both aspartate aminotransferase (AST) and alanine transaminase (ALT) levels. LMWH, low-molecular-weight heparin; UFH, unfractionated heparin. *p<0.05, statistically significant.

Reference

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