CLINICAL ARTICLE Duration and cessation characteristics of heparinization after finger replantation: A retrospective analysis of outcomes Johnny I. Efanov, MD | Julia Khriguian, MD | Sophie Cassier, MD | Elie Boghossian, MD, MSc | Patrick G. Harris, MD | Joseph Bou-Merhi, MD | M. A. Danino, MD, PhD Department of Plastic and Reconstructive Surgery, Centre Hospitalier de l’Universit e de Montr eal (CHUM), University of Montreal, Canada Correspondence Johnny Ionut Efanov, MD, Department of Plastic and Reconstructive Surgery, Centre Hospitalier de l’Universit e de Montr eal (CHUM), 1560 rue Sherbrooke Est, Montreal, Quebec, Canada, H2L 4M1, Tel.: 1.514.890.8000 ext 23757. Fax: 1.514.465.1773, Email: johnny.ionut.efanov@umontreal.ca Abstract Background: To prevent postoperative thrombosis, indications for anticoagulation in finger replantation have been described, but no consensus has yet been found for cessation protocols. The aim of this study is to investigate cessation methods of intravenous anticoagulation after fin- ger replantation. Methods: A retrospective review of all patients treated for a finger replantation between Decem- ber 2014 and July 2016 was performed. Only those who required postoperative treatment with intravenous heparin were extracted. Primary outcome was survival of finger at hospital discharge and data collection focused on postoperative anticoagulation regimens. Results: 108 patients with replantation were treated with intravenous heparin and included in the analysis. When anticoagulated, survival rate was 60% (n 5 65) at hospital discharge, wherein arte- rial and venous thrombosis accounted for 60 and 40% respectively. Descriptive analysis failed to demonstrate an increase in failure rates when tested for duration of intravenous heparin, fixed or variable infusion rates of anticoagulation and need for vascular grafts. However, there was a 2.8- fold (P 5 .009) increase in the survival rate with progressive weaning of anticoagulation rather than abrupt discontinuation. Subgroup analysis demonstrated similar findings when considering arterial thrombosis alone (OR 5.2, P 5 .012), but did not show any significant difference for venous thrombosis (OR 1.7, P 5 .344). Conclusions: Progressive tapering of intravenous heparin is associated with an increased survival rate after finger replantation, particularly for arterial thrombosis. Further prospective and random- ized trials are necessary to elucidate the optimal duration, method of infusion and indications for vascular grafts. 1 | INTRODUCTION Successful surgical management of patients with upper extremity ampu- tations relies foremost on surgeons’ clinical judgment with regards to what constitutes an appropriate indication for replantation (Barbary, Dap, & Dautel, 2013; Pomerance et al., 1997). Based on evidence, few dispute that the mechanism of injury, level of amputation and surgical technique constitute the main factors influencing the prognosis of finger replants (Velanovich et al., 1988). Despite improvements in microsurgical skills and a more selective approach to replantation, failure rates remain important, ranging from 5 to 43% (Fufa, Calfee, Wall, Zeng, & Goldfarb, 2013; Yu et al., 2015). Failures can be categorized as functional or vascu- lar, with the later associated to thromboses in the early postoperative course (Efanov et al., 2016). Much has been attempted to minimize failure rates due to vascular complications, mainly with the addition of thromboprophylactic regimens Microsurgery. 2017;1–8. wileyonlinelibrary.com/journal/micr V C 2017 Wiley Periodicals, Inc. | 1 Received: 7 March 2017 | Revised: 18 April 2017 | Accepted: 9 June 2017 DOI: 10.1002/micr.30194