ReviewA review of traditional and novel oral anticoagulant and antiplatelet therapy for dermatologists and dermatologic surgeons
Section snippets
Warfarin
With more than 33 million prescriptions written each year, warfarin is the most ubiquitous anticoagulant prescribed. Warfarin's indications and mechanism of action are listed in Table I and Fig 1.9, 10, 11, 12, 13, 14, 15, 16 Numerous medications and supplements have potentially significant interactions with warfarin because of extensive protein binding and CYP2C9 metabolism (Table II).17
Bleeding is the major adverse event associated with warfarin, and risk of hemorrhage increases with the
Aspirin
Aspirin (acetylsalicylic acid) remains the cornerstone of antiplatelet therapy because of its proven benefit and low cost.41 In patients with known atherosclerotic disease, aspirin reduced serious vascular events (myocardial infarction, CVA, death) by 14% to 25%, and the benefit substantially outweighed the bleeding risk (Table I).42, 43, 44, 45
Activated platelets release thromboxane A2, which promotes platelet aggregation, vasoconstriction, and further platelet activation. Aspirin irreversibly
Dietary supplements
Use of complementary and alternative medicine products is steadily increasing. Up to 27% of surgical patients consume over-the-counter products that theoretically inhibit coagulation (Table IV).57, 58 Activity may be intrinsic to the compound or may be a result of synergistic effects in combination with standard anticoagulants. Importantly, formulations of these supplements can vary greatly because they are not subjected to FDA scrutiny like prescription medications. This variability hinders a
Anticoagulant and antiplatelet agents: Current recommendations in dermatologic surgery
The overall rate of perioperative or postoperative hemorrhage or hematoma formation in dermatologic surgery is extremely low (0.89% of cases).1 The consensus in recent literature favors perioperative continuation of medically necessary anticoagulant or antiplatelet medications in dermatologic surgery despite any perceived or real increased risk of hemorrhagic complications. Five recent studies have evaluated this bleeding complication risk. Warfarin confers a 7- to 9-fold increased risk of
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Conflicts of interest: None declared.