Hemorrhagic complications in dermatologic surgery

Abstract

The ability to recognize, manage, and, most importantly, prevent hemorrhagic complications is critical to performing dermatologic procedures that have safe and high quality outcomes. This article reviews the preoperative, intraoperative, and postoperative factors and patient dynamics that are central to preventing such an adverse outcome. Specifically, the role that anticoagulants and antiplatelet agents, hypertension, and other medical conditions play in the development of postoperative hemorrhage are discussed. In addition, this article provides practical guidelines on managing bleeding during and after surgery.

A review of traditional and novel oral anticoagulant and antiplatelet therapy for dermatologists and dermatologic surgeons

“…Because of age (average eighth decade) many dermatologic surgery patients have comorbidities requiring anticoagulation; approximately 46% of cutaneous surgery patients may take at least 1 anticoagulant or antiplatelet agent. [1][2][3] Bleeding risk associated with perioperative use of traditional anticoagulant or antiplatelet agents (warfarin, aspirin, and clopidogrel) has been previously reported [1][2][3][4][5][6] ; newer oral anticoagulant (dabigatran, rivaroxaban, and apixaban) and antiplatelet (prasugrel and ticagrelor) medications may pose similar risks to patients undergoing dermatologic surgery. In addition, over half of adults use over-thecounter products that may increase bleeding, and almost half of these patients do not report taking these supplements to their doctors.…”

“…1 Although more complex dermatologic surgeries may have increased complications secondary to bleeding, it is expected that even these procedures would be unlikely to lead to life-threatening hemorrhagic complications. [1][2][3][4][5][6] However, dermatologic surgeons must be cognizant of the risks presented by individual patients. Because of age (average eighth decade) many dermatologic surgery patients have comorbidities requiring anticoagulation; approximately 46% of cutaneous surgery patients may take at least 1 anticoagulant or antiplatelet agent.…”

Postoperative Anaemia Is a Risk Factor for Bleeding-Related Event in Thromboprophylaxis Using Fondaparinux Sodium Injection after Total Knee or Hip Arthroplasty

“…This analysis identified 12 risk factors for bleeding in general surgery: anaemia and thrombocytopenia on admission and at POD1; activated partial thromboplastin time (aPTT) > upper limit of normal (ULN) and prothrombin time − international normalized ratio (PT-INR) > ULN on POD1; surgical type (TKA); concomitant use of antiplatelet medications; FPX dose of 2.5 mg/d; body weight <50 kg; age >75 years; and creatinine clearance <50 mL/min. [20][21][22] Anaemia and thrombocytopenia on admission and at POD1 were defined as haemoglobin < lower limit of normal (LLN) (male: 13.2 g/dL; female: 10.8 g/dL) and platelet count < LLN (130000/µL), respectively. The ULN for aPTT and PT-INR was defined as 40 s and 1.2, respectively.…”

Complications of cutaneous surgery

“…For smaller arteriolar or venular bleeding, electrosurgery or heat cautery should be utilized. Larger arterial or venous bleeding usually requires ligation of the vessels using absorbable sutures 36 . In the postoperative period, the greatest risk of bleeding is in the first 24 hours.…”