Complications in skin grafts when continuing antithrombotic therapy prior to cutaneous surgery requiring skin grafting: an observational study

Direct oral anticoagulants in skin surgery: a systematic review of their complications and recommendations for perioperative management

“…Of the 13 articles, four were prospective observational cohort studies, one was a retrospective case-control study, and the remaining eight were retrospective observational cohort studies (Appendix S1). [15][16][17][18][19][20][21][22][23][24][25][26][27] Over 12 years, there were 10,750 patients who underwent cutaneous surgery, with 1,312 of them performed on patients prescribed a DOAC. The mean participant age ranged from 68 to 78.8 years of age, with a male predominance (49.9-81.8%).…”

“…The included articles studied four areas: (1) complication rate in those who continued DOAC therapy, 15,16 (2) complication rate in those who ceased DOAC therapy prior to undergoing skin surgery, 17,18 (3) complication rate between patients who had their DOAC therapy ceased vs continued, 19 and (4) comparing complication rate in patients anticoagulated with a DOAC agent vs a control group not on a DOAC agent (Table 1). [20][21][22][23][24][25][26][27] Outcomes DOAC continuation Antia et al 15 evaluated 76 MMS on patients who were prescribed a DOAC, resulting in one mild bleeding complication in a person taking rivaroxaban (1.32%). Chang et al conducted 46 procedures in patients on DOAC therapy (41 on dabigatran and five on rivaroxaban).…”

“…As a whole, the evidence surrounding the perioperative management of DOACs in patients who undergo skin surgery offered no single unifying recommendation. [15][16][17][18][19][20][21][22][23][24][25][26][27] Many authors deemed the continuation of DOAC therapy throughout the procedure to be safe or that there was no increased risk of hemorrhagic complications. 15,16,23,25 In contrast, various authors found that interrupting DOAC therapy conferred little thromboembolic risk while minimizing hemorrhagic complications.…”

“…33 Many studies included did not have a sufficient sample size of patients receiving DOAC therapy to amount to statistical power, [16][17][18]20,25 and either did not have a comparator control cohort [15][16][17][18] or had a control cohort without clinician blinding. 21,22,27 Often, there was very little definition provided for hemorrhagic complication and the level of intervention required to achieve hemostasis, while only one study attempted to stratify patients based on the dose of their DOAC (low-dose vs highdose apixaban and rivaroxaban). 19 Only one study attempted to account for confounders associated with hemorrhagic or thromboembolic complications (e.g., smoking, comorbidities, procedure, and closure type).…”

“…Eight of the 13 articles evaluated the rate of hemorrhagic complications in patients undergoing skin surgery (Table 1), comparing those on a DOAC with a control group (Figure 2). [20][21][22][23][24][25][26][27] Studies with non-events were excluded from graphical comparison.…”