Dermatologic surgeryMultiple antithrombotic agents increase the risk of postoperative hemorrhage in dermatologic surgery
Section snippets
Methods
This was a retrospective chart review study approved by the Lifespan institutional review board (Providence, RI). All patients who underwent both Mohs micrographic surgery and postoperative care at our university dermatology department from June 1, 2005, to June 1, 2006, were included (Table I). These patients were identified from the Mohs micrographic surgery database.
Age, preoperative and postoperative blood pressure, alcohol intake, antiplatelet or anticoagulant agent use, cancer type,
Results
A total of 760 patients of 847 were eligible and included in the final analysis. Patients who underwent repair and follow-up care by plastic surgeons or about whom data were missing were excluded from analysis (Table I).
The median patient age was 73 years. Of patients, 62.5% were taking no antithrombotic agents at the time of surgery; 29.9% were taking one antithrombotic agent, and 7.6% two or more antithrombotic agents. The most commonly used antithrombotic agent was aspirin, in 28% of
Discussion
Medical prevention of thrombotic events involves the use of traditional antiplatelet agents and anticoagulant agents, and over-the-counter supplements such as vitamin E, gingko, and fish oil. Aspirin, clopidogrel, and dipyridamole are all antiplatelet agents, whereas heparin and warfarin are anticoagulant agents. Their mechanisms differ. Aspirin irreversibly inhibits the cyclo-oxygenase 1 enzyme, leading to decreased production of thromboxane A2, which induces platelet aggregation. Clopidogrel
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Preventing complications in dermatologic surgery: Presurgical concerns
2021, Journal of the American Academy of DermatologyCitation Excerpt :Small locally administered doses of lidocaine and epinephrine are generally considered safe if not injected intravascularly, because endogenous epinephrine release during times of stress is greater than what would be introduced via injection during cutaneous surgery.39,40 Prescription medications, over-the-counter drugs, and herbal supplements can all impair clotting (Table I), and approximately 25% to 38% of patients undergoing dermatologic surgery take antithrombotic medications.41-43 Early studies showed a nonsignificant difference in postoperative bleeding in patients taking aspirin, warfarin, or nonsteroidal anti-inflammatory drugs versus control subjects, while intraoperative bleeding was either nonsignificant or easily controlled.44-46
Direct-acting Oral Anticoagulants in Dermatologic Surgery
2020, Actas Dermo-SifiliograficasOptimizing Patient Safety in Dermatologic Surgery
2019, Dermatologic ClinicsCitation Excerpt :It is estimated that between 25% and 38% of patients undergoing dermatologic surgery take medication that alters hemostatic mechanisms.34–36 Although there is an increased postoperative bleeding risk in patients taking more than 1 anticoagulant, especially those on both warfarin and clopidogrel, overall risk of continuation remains low.34–36 Many studies have shown no real increase in major complications with anticoagulation continuation, while showing increases in life-threatening consequences with their discontinuation.37–39
Bleeding on the cutting edge: A systematic review of anticoagulant and antiplatelet continuation in minor cutaneous surgery
2018, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Patients taking both clopidogrel and aspirin had significantly more severe bleeding complications than those on aspirin alone (4% versus 0.5%, odds ratio 7.8 (1.7–36.3); (p = 0.009). Shimizu et al (2008) retrospectively compared bleeding complications between patients on single, multiple-agent and no-agent regimens.37 They demonstrated a significantly increased complication rate in the multiple-agent group (n = 58) compared to both single-agent and no-agent groups (n = 702) (p = 0.016), although there were only 4 complications in total.
Characterization of Surgical Procedures in the Spanish Mohs Surgery Registry (REGESMOHS) for 2013-2015
2017, Actas Dermo-Sifiliograficas
Funding sources: None.
Conflicts of interest: None declared.
Presented orally at the 2007 Annual Meeting of the American College of Mohs Micrographic Surgery and Cutaneous Oncology, Naples, Fla, May 2007.