- See:
-
Aspirin
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Heparin
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Dipyridamole
-
Verapamil
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Warfarin
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Urokinase
- Prevention of Thrombosis in Microvascular Surgery:
- most significant factor in patency of microvascular anastomoses is flawless surgical technique;
- small pieces of adventia caught in the anastomosis provide a nidus for platlet thrombus formation;
- leaking from of blood thru gap in suture line requires platlet thrombus to occulde the
gap, which may extend into luminal wall;
- more common is the problem caused by a suture that includes a portion of the back wall and thereby obstructs the lumen;
- eversion of the suture with too large bite may also decrease diameter of the lumen and invites thrombus formation;
- disappearance of pulse suggest development of thrombus at site of arterial repair, whereas rapid development of edema in extremity
may be assoc w/ thrombosis at the site of the venous repair;
- Antiplatlet Agents:
- antiplatlet drugs,
ASA &
dipyridamole, are used systemically for their ability to stabilize platlets;
- aspirin and dypyridamole have a specific effect on inhibiting the release of adenosine diphosphate (ADP) in response to collagen;
- 300 mg of ASA is given at surgery and daily therafter;
- on vessel wall, Prostacyclin has beneficial effect of inhibiting platlet aggregation;
- this effect is abolished by doses of ASA above 4.9 mg/kg
- effect of aspirin on the platlet is inhibition of thromboxane, potent platlet aggregator;
- doses below 3.2 mg/kg selectively inhibit thromboxane production on the platlet without interfering with prosta-
cycline production in vascular endothelial cells;
- dipyridamole has an additional vasodilator effect that lasts approximately 24 hrs; the dose is 100 mg PO tid;
- Heparin:
- at present, no significant improvement in patency rates has been acheived with the prophylactic use of heparin;
Acute lower limb ischemia: failure of anticoagulant treatment to improve one-month results of arterial thromboembolectomy. A mprospective
randomized multi-center study.
Washout of vessels with heparin does not improve patency following severe microarterial trauma: an experimental study.
Beneficial effects of intra-arterial reserpine after upper-extremity embolectomy: a prospective randomised trial.
Intra-arterial thrombolytic therapy in peripheral vascular disease.
Evaluation of the effect of pharmacologic agents on crush-avulsion arterial injuries: a scanning electron microscopy study.
Oxygen-derived free radicals in postischemic tissue injury.
The effects of inhalation anesthetic agents on survival in a pig random skin flap model.
Involvement of reactive oxygen species in post-ischaemic flap necrosis and its prevention by antioxidants.
Nicotinamide enhances skin flap survival.
Deferoxamine attenuates ischemia-induced reperfusion injury in the skin and muscle of myocutaneous flaps in the pig.
A comparative analysis of the ability of five classes of pharmacological agents to augment skin flap survival in various models and species: an attempt to standardize skin flap research.
Ischaemia reperfusion injury in pedicle skin flaps in the pig: lack of protective effect of SOD and allopurinol.
The effects of allopurinol and superoxide dismutase in a rat model of skin flap necrosis.
The effects of pentoxifylline on random skin flap survival.
Fasciocutaneous flaps: an experimental model in the pig.
Pharmacologic manipulation of random skin flaps with pentoxifylline.
A comparative study on the effect of various pharmacological agents on the survival of skin flaps in the rat.
Involvement of reactive oxygen species in post-ischaemic flap necrosis and its prevention by antioxidants.
Tissue oxygen tension in random pattern skin flaps during normovolemic
Augmentation of critical skin flap survival following ibuprofen therapy.
A comparative study of skin blood flow in musculocutaneous and random pattern flaps.
Drug treatment and flap survival.
Experimental study of the influence of arterial trauma on dependent distal tissue survival.
