Intravenous Bolus Infusion of Heparin for Circulatory Insufficiency after Finger Replantation

ABSTRACT

When heparin 2,500 to 5,000 U was administered by intravenous bolus infusion to 13 fingers that had developed arterial thrombosis after replantation, complete survival was achieved in seven of 13 fingers. If fingers demonstrating partial necrosis were included, survival was obtained in 11 of 13 fingers. In nine fingers in which survival was obtained and follow-up observation was possible, sensory recovery was favorable, and there was no limitation in the use of the affected fingers, although mild atrophy of the pulp and nail deformity were noted in fingers with partial necrosis. Using a model of arterial thrombosis created in the carotid arteries of Sprague-Dawley rats, the authors investigated how the intravenous bolus infusion of heparin affected thrombolysis. During the early phase of arterial thrombosis when the thrombus is fragile, the intravenous bolus of heparin affected the balance between coagulation and fibrinolysis, facilitating the thrombolytic process, and increasing the rate of recanalization of the occluded arteries. Since an intravenous bolus injection of heparin is an easy procedure, without the risk of any severe side effects, this method should be considered in such cases of arterial thrombosis, with attention paid to the general condition of the patient.