Dermatologic surgery
Multiple antithrombotic agents increase the risk of postoperative hemorrhage in dermatologic surgery

https://doi.org/10.1016/j.jaad.2008.01.014Get rights and content

Background

Studies show that holding single antithrombotic agents perioperatively increases the risk of acute thrombotic events and does not significantly decrease the risk of bleeding complications in dermatological surgery. Recent data suggest that selected patients may benefit from combination therapy in preventing acute thrombotic events.

Objective

We sought to evaluate postoperative bleeding complications in patients who underwent Mohs micrographic surgery while using multiple agents perioperatively compared with patients using a single agent or none at all.

Methods

We conducted a retrospective chart review of patients treated in one academic Mohs micrographic surgery department during 1 year.

Results

Patients taking two or more agents at the time of surgery were more likely to bleed than those taking one agent or none at all (P = .0016, Fisher's exact).

Limitations

Small sample size and retrospective nature were limitations.

Conclusion

Perioperative use of more than one antithrombotic agent increases postoperative bleeding risk.

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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    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.

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