The Role of Intravenous Heparin Following Digital Replantation: A Retrospective Cohort Study on 1,155 Digits

J Hand Surg Am. 2023 Mar;48(3):263-272. doi: 10.1016/j.jhsa.2022.08.011. Epub 2022 Oct 18.


Purpose: The purpose of this study was to determine if the use of postoperative therapeutic dose intravenous heparin (POTDIVH) was indicated in digital replantation and revascularization by assessing digit survival and complications associated with heparin.

Methods: All patients with amputation distal to the carpal tunnel treated at our center from 2004 to 2020 were included for chart review. Digit survival and complication rates were compared between patients who received POTDIVH (group A) and those who did not (group B). Logistic regression analysis and subgroup analysis were conducted.

Results: A total of 795 patients (1,155 digits) were included in this study (248 patients/374 digits in group A and 547 patients/781 digits in group B). The overall revascularization and replantation success rate was 79.9% in the POTDIVH group and 92.8% in the non-POTDIVH group. In our retrospective regression and subgroup analyses, group A demonstrated increased odds of failure compared with group B and was associated with increased bleeding-related complications. Subgroup analyses stratified by the mechanism of injury and vein grafting also showed a significantly decreased survival in the POTDIVH group.

Conclusions: Our retrospective data seem to indicate that heparin in digit replantation and revascularization appears to have no benefit on digit survival across all subgroups, including crush and avulsion injuries, and is associated with a significantly increased rate of complications.

Type of study/level of evidence: Therapeutic IV.

Keywords: Digital; heparin; replantation; retrospective; revascularization.

MeSH terms

  • Amputation, Traumatic* / surgery
  • Finger Injuries* / surgery
  • Fingers / surgery
  • Heparin
  • Humans
  • Replantation
  • Retrospective Studies


  • Heparin