Cutaneous Surgery in Patients Receiving Warfarin Therapy

Controversies in Perioperative Management of Blood Thinners in Dermatologic Surgery: Continue or Discontinue?

“…These data include those we published previously. 3 Sixty-eight consecutive patients receiving warfarin for various conditions, who underwent cutaneous surgery at our institute between November 1999 and September 2003, were evaluated prospectively for potential adverse effects of warfarin therapy, both operatively and postoperatively. We noted intra-and postoperative bleeding and patients were asked to report further bleeding after discharge.…”

The Management of Antithrombotic Medication in Skin Surgery

“…Both patient populations underwent dermatologic surgery on the same days, and there was no difference in bleeding complications between the two groups. 17 The results showed no increase in significant intra-or perioperative bleeding in patients taking warfarin, and the authors noted that acceptable cosmetic results were achieved regardless of warfarin administration. 17 The study concluded that continuous anticoagulation with warfarin is safe for patients undergoing cutaneous surgery if their INR is between 2 and 3.5.…”

“…17 The study concluded that continuous anticoagulation with warfarin is safe for patients undergoing cutaneous surgery if their INR is between 2 and 3.5. 17 INR levels should be checked up to 1 week before cutaneous surgery. Discontinuation of warfarin is not recommended in light of the potentially devastating thromboembolic events that can occur with only brief drug cessation.…”

“…According to the FDA, 2 million new patients are prescribed warfarin each year, and approximately 1.5% to 4% of patients who present for dermatologic surgery are taking warfarin. 2,17,18 Warfarin's anticoagulant properties were discovered in the 1920s when Midwestern farmers noticed that their cattle were dying of a hemorrhagic disease within days of eating moldy sweet clover hay. 19 The drug was originally promoted to farmers as a potent rodenticide in the 1940s, but over the following decade, its use was expanded to humans as an anticoagulant.…”

Dermatologic Surgery in the Demented Patient

“…Specific attention should be focused on compiling a complete list of medications and documenting any known allergies, bleeding disorders, or use of anticoagulants such as aspirin, nonsteroidal anti-inflammatory drugs, warfarin, vitamin E, alcohol, and homeopathic remedies that may potentially increase bleeding (i.e., ginkgo and garlic). [3][4][5][6][7][8][9][10][11] Alcohol abuse is also a relative contraindication to dermatologic surgery. 12,13 Cutaneous surgery on normal or demented patients taking anticoagulants raises questions about the potential for bleeding complications.…”