Multiple antithrombotic agents increase the risk of postoperative hemorrhage in dermatologic surgery

Prospective multicentre cohort study on 9154 surgical procedures to assess the risk of postoperative bleeding – a DESSI study

“…found that a severe complication of Mohs surgery was eight times more likely in patients taking ASA and clopidogrel (10/258 cases: 3.9%) compared with the ASA control group (2/395 cases: 0.5%). Other authors confirmed an increase in bleeding complications in patients taking more than one anticoagulant …”

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

“…Multiagent regimen, e.g. aspirin plus clopidogrel, was associated with higher risk of significant postoperative bleeding and graft necrosis, as reported in two studies [8,12]. Overall, most of the reviewed studies suggest that the use of antithrombotic therapy can increase the risk of bleeding complications in skin grafts and care should be taken when operating on these patients.…”

“…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].…”

Complications of cutaneous surgery in patients taking clopidogrel-containing anticoagulation

“…To our knowledge, only a single study, designed to examine the risk of postoperative hemorrhage in patients taking multiple antithrombotic agents, has documented the tendency for increased bleeding in patients taking clopidogrelcontaining anticoagulation. 14 Therefore, the frequency of postoperative bleeding and other complications in patients taking clopidogrel at the time of cutaneous surgery has not been well established. Because clopidogrel is usually prescribed in combination with another anticoagulant (eg, aspirin), we use the term ''clopidogrel-containing anticoagulation'' to describe the treatment of the population of patients being studied.…”