Phlebitis Induced by Intravenous Prostaglandin E1 in Patients with Malignancy Following Flap Reconstruction: A Case Series Study

Abstract

Hsing-Yu Hsu, Yih-Dih Cheng, Yi-Fei Lai, Yow-Wen Hsieh and Ching-Ya Huang

Background: Prostaglandin E1 (PGE1) is a vasodilator and smooth-muscle relaxant commonly used in patients with free flap reconstruction to increase the survival rate of the flap. However, phlebitis is the most common adverse event in patients who receive an intravenous solution of PGE1, and it will lead to more medical treatment.

Objective: The incidence of PGE1-induced phlebitis has not been well examined. This study aimed to determine which patient characteristics increase the risk of PGE1-induced phlebitis. Methods: We retrospectively reviewed the medical records of patients with phlebitis caused by PGE1 in our hospital from May 2018 to May 2019. Among the records, we focused on patients with head and neck malignancy who received free flap reconstruction.

Results: In total, 1026 patients were prescribed PGE1, and 13 patients developed PGE1-induced phlebitis. Among 78 patients with head and neck cancer, the incidence rate of phlebitis was 15.4% (12 patients). These patients’ mean age was 56 ± 9 years, and all were men. Their mean body weight, estimated glomerular filtration rate, serum creatinine level, white blood cell count, and neutrophil count were 69.6±12.6kg, 81 ± 18 mL/min/1.73 m2, 0.97 ± 0.19 mg/dL, 10.3 ± 4.4 103/μL, and 75% ± 12%, respectively, before PGE1 administration. The white blood cell count before PGE1 administration was significantly higher (p<0.05) in patients with phlebitis than in those without phlebitis.

Conclusion: Prescribers of PGE1 should be aware that patients with head and neck malignancy who receive flap reconstruction may have an increased risk of phlebitis. These patients should be monitored upon admission to prevent PGE1-induced phlebitis.

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