Continuing warfarin during cutaneous surgery

Sugden, Paul; Siddiqui, H.

doi:10.1016/s1479-666x(08)80110-2

Cited by 11 publications

(7 citation statements)

References 17 publications

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“…In patients receiving antithrombotic therapy, plastic surgeons and dermatologists must balance the risk of bleeding against the risk of thrombotic complications that may occur when discontinuing the therapy. A number of studies indicate that primary closure is associated with a low rate of complications when antithrombotic therapy is continued in order to avoid adverse thrombotic events [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Furthermore, the Danish Association of Thrombosis and Hemostasis recommends not to discontinue antithrombotic therapy in patients undergoing minor surgery [19].…”

Section: Introductionmentioning

confidence: 99%

Complications in skin grafts when continuing antithrombotic therapy prior to cutaneous surgery requiring skin grafting: A systematic review

Jarjis

Jørgensen

Finnerup

et al. 2014

Journal of Plastic Surgery and Hand Surgery

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The risk of postoperative bleeding and wound healing complications in skin grafts among anticoagulated patients undergoing cutaneous surgery has not been firmly established. The objective was to examine the literature and assess the risk of postoperative bleeding or wound healing complications in skin grafts among anticoagulated patients, compared with patients who discontinue or patients who are not receiving antithrombotic therapy prior to cutaneous surgery requiring skin grafting. A systematic review examining the effect of antithrombotic therapy on cutaneous surgery was performed according to the PRISMA-guidelines. PubMed and Embase databases were primarily searched for relevant literature in the period from the start date of each database to 2014. A total of eight studies representing 443 patients met criteria for inclusion. No randomised controlled trials were found; the included studies were of prospective and retrospective design. Most of the reviewed studies suggest that the use of antithrombotic therapy can increase the risk of bleeding complications in skin grafts. These complications are only wound threatening and not life threatening. Therefore, this is of concern mostly in terms of hemostasis by the surgeon and good pressure dressings. Care should be taken when operating on anticoagulated patients undergoing cutaneous surgery requiring skin grafting. However, graft failure is rare and, given the risk of thrombotic events, the reviewed studies recommend continuing all medically necessary antithrombotic therapy. The limitations of this study are the small sample sizes and the level of evidence; hence, more research is needed to substantiate these preliminary findings.

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Section: Introductionmentioning

confidence: 99%

Complications in skin grafts when continuing antithrombotic therapy prior to cutaneous surgery requiring skin grafting: A systematic review

Jarjis

Jørgensen

Finnerup

et al. 2014

Journal of Plastic Surgery and Hand Surgery

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“…12 The study included 51 patients, average age of 73 years, with an INR less than 4 prior to the procedure. The most common indication for warfarin was atrial fibrillation.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Although this study did not use statistical methods, the authors recommend that continuation of anticoagulation around minor cutaneous procedures is safe assuming that the patient's INR is therapeutic on the day of surgery. 12 Thrombotic complications were evaluated by Kovich and Otley who surveyed 504 members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology regarding thrombotic complications when anticoagulants were withheld. 13 Questions included in the survey sought to obtain information regarding the patient, procedure, indication and type of anticoagulant, and thrombotic complications.…”

Section: Literature Reviewmentioning

confidence: 99%

Management of Warfarin in Patients Desiring Tattoo Placement

Causey

Hodulik

2013

Journal of Pharmacy Technology

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Objective: To provide a review of the primary literature regarding recommendations for management of chronic warfarin therapy during tattoo placement. Data Sources: PubMed and IDIS were searched (up to May 2013) using the search terms vitamin K antagonists, warfarin, anticoagulation, tattoo, tattoo placement, cutaneous procedure, and cutaneous surgery. Study Selection and Data Extraction: No trials including subjects on warfarin undergoing tattoo placement were identified. Clinical trials were included if they were published in English and included subjects on chronic warfarin therapy undergoing cutaneous procedures. Tattoo placement is similar to cutaneous procedures as skin is marked by puncturing into the dermal layer and inserting pigments, and minor bleeding is possible. Thus, recommendations of anticoagulation management for cutaneous procedures were evaluated. Data Synthesis: Eleven articles evaluating warfarin continuation around cutaneous surgery met selection criteria. Ten articles evaluated hemorrhagic complications, and 1 article evaluated thrombotic risk of perioperative anticoagulation discontinuation. In patients continuing warfarin compared to discontinuing warfarin, perioperative bleeding rate was statistically higher in 4 studies, trended higher in 3 studies, and was comparable in 3 studies. Thrombotic risk was increased when warfarin was withheld perioperatively from patients on chronic therapy. Conclusions: Trials evaluating chronic warfarin therapy in patients undergoing cutaneous surgery have conflicting recommendations for warfarin continuation through surgery. At a minimum, international normalized ratio should be evaluated prior to procedures with delay if the international normalized ratio is elevated. Thrombotic risk should be fully assessed prior to holding warfarin in patients on chronic warfarin therapy. Trials evaluating management of chronic warfarin therapy in the setting of tattoo placement are needed.

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“…There are reasonable data to suggest that minor procedures such as tooth extractions, skin biopsies, pacemaker placement, and cataract removal do not require cessation of VKAs [101][102][103][104]. This information is not widely known and many surgeons refuse to perform such procedures while patients are on VKAs.…”

Section: Bridging With Heparinsmentioning

confidence: 99%

Stroke Prevention Treatment of Patients with Atrial Fibrillation: Old and New

Bal

Ojha

Hill

2010

Curr Neurol Neurosci Rep

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Atrial fibrillation is the most common cause of cardioembolic ischemic stroke and has a rising prevalence worldwide. Stroke prevention in this condition is poised to take a substantial leap forward with the evolution of new anticoagulant medications, with superior properties compared to vitamin K antagonists. New, safer and more effective chronic therapy is on the horizon. However, many issues surrounding the management of stroke prevention after an acute stroke and during the course of chronic anticoagulant therapy remain to be resolved.

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Continuing warfarin during cutaneous surgery

Cited by 11 publications

References 17 publications

Complications in skin grafts when continuing antithrombotic therapy prior to cutaneous surgery requiring skin grafting: A systematic review

Complications in skin grafts when continuing antithrombotic therapy prior to cutaneous surgery requiring skin grafting: A systematic review

Management of Warfarin in Patients Desiring Tattoo Placement

Stroke Prevention Treatment of Patients with Atrial Fibrillation: Old and New

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