Although anticoagulation therapy has been part of replantation therapy for 45-years, no consensus exists on the use of antithrombotic agents. Our replantation patients have been routinely treated with a combination of 240,000 IU/d of urokinase and 80 μg/d of prostaglandin E1 for 7 days, which is added to an intravenous drip infusion of 2,000 ml/d of hydroxyethylated starch. If the crushing of the replanted digits distal to the metacarpophalangeal joints is severe, heparin is added and administered continuously for 1 week. This report discusses the use of postoperative antithrombotic agents based on our experience with 29-patients. The amputation levels included six digits in zone I, 13 digits in zone II, 10 digits in zone III, eight digits in zone IV, and two digits in zone V. The injury types included clean-cut and crush (7 cases), and compression and avulsed (22 cases). Unlike our anticoagulation protocol, heparin was used in 28 patients, independently of amputated parts and types of injury. Additionally, patients aged 50 years and older were administered significantly less total heparin than patients aged 50 years and younger. Our findings suggest that heparin is the most beneficial agent for antithrombotic therapy in patients with replanted digits.
