Perioperative complications with new oral anticoagulants dabigatran, apixaban, and rivaroxaban in Mohs micrographic surgery: A retrospective study

Antia, Camila; Hone, Natalie; Gloster, Hugh Morris

doi:10.1016/j.jaad.2017.05.038

Cited by 21 publications

(17 citation statements)

References 5 publications

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“…29,30 It has been demonstrated that the bleeding-risk might be increased by DOAC-therapy, and in some cases, even severe post-operative bleeding has been described. [31][32][33][34][35] Our study showed a rate of severe bleeding of 2.67% under api/dab and 0.79% under riv/edo, without significant difference compared to patients without AP/ AC-medication. Thus, the risk of severe bleeding was not increased under DOAC.…”

Section: Discussionmentioning

confidence: 47%

“…An interdisciplinary study with a predefined dosing regimen for DOAC showed rates of severe bleeding of 0.59% (apixaban), 0.91% (dabigatran) and 1.27% (rivaroxaban) in the overall group, but no bleeding event in the subgroup of dermatological patients 29,30 . It has been demonstrated that the bleeding‐risk might be increased by DOAC‐therapy, and in some cases, even severe post‐operative bleeding has been described 31–35 . Our study showed a rate of severe bleeding of 2.67% under api/dab and 0.79% under riv/edo, without significant difference compared to patients without AP/AC‐medication.…”

Section: Discussionmentioning

confidence: 54%

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Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery—A prospective observational study

Höper,

Rosen,

Kofler

et al. 2023

Acad Dermatol Venereol

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BackgroundPerioperative management of antiplatelet and anticoagulant (AP/AC) therapy is a matter of balancing the risks of bleeding and thromboembolic events. Reliable data for dermatosurgery are still lacking, especially for direct oral anticoagulants (DOAC).ObjectivesThe aim was to prospectively evaluate the influence of AP/AC‐medication on bleeding risk in dermatosurgery with focus on exact intervals between DOAC intake and procedure performed on post‐operative bleeding.MethodsPatients with or without AP/AC‐therapy were included in the study without randomization. Exact times of DOAC‐intake, procedure performed and post‐operative bleeding were documented. Data collection was prospectively and standardized done by one person.ResultsWe evaluated 1852 procedures in 675 patients. Post‐operative bleeding occurred after 15.93% (n = 295) of all procedures, but only a few of them were severe (1.57%, n = 29). Compared to patients without AP/AC‐medication, severe post‐operative bleeding occurred significantly more often under dual antiplatelet therapy (11.76%, n = 2; p = 0.0166) and bridging of either vitamin K antagonist (9.09%, n = 2; p = 0.0270) or DOAC (15.38%, n = 2; p = 0.0099). There was no significant difference in the frequency of severe bleeding regarding to the preoperative DOAC‐free period.ConclusionsAlthough AP/AC‐therapy is associated with a significant higher rate of post‐operative bleeding, no life‐threatening bleeding was recorded. Long preoperative pausing or bridging of DOAC does not lead to significantly less severe bleeding events.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 54%

Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery—A prospective observational study

Höper,

Rosen,

Kofler

et al. 2023

Acad Dermatol Venereol

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“…[32][33][34][35][36][37][38][39] Recommendations in the facial plastics and dermatologic literature also suggest that continuation of antithrombotic medications is associated with low rates of severe hemorrhagic complications. 8,30,[40][41][42] However, it is important to note that results from other specialties may not be transferable due to the unique risk of vision loss with oculoplastic surgeries. The surgeon must assess both the risk and impact of hemorrhage in different oculoplastic procedures based on the nature of incision, depth of dissection, duration of case, ability to easily cauterize or tamponade (e.g., easy with enucleation, difficult with decompression), and the ramifications of bleeding.…”

Section: Understanding Surgical Bleeding Riskmentioning

confidence: 99%

Perioperative Considerations for Antithrombotic Therapy in Oculofacial Surgery: A Review of Current Evidence and Practice Guidelines

Kim

Pfeiffer

Chang

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Recent survey studies have demonstrated wide variability in practice patterns regarding the management of antithrombotic medications in oculofacial plastic surgery. Current evidence and consensus guidelines are reviewed to guide perioperative management of antithrombotic medications.Methods: Comprehensive literature review of PubMed database on perioperative use of antithrombotic medication.Results/Conclusions: Perioperative antithrombotic management is largely guided by retrospective studies, consensus recommendations, and trials in other surgical fields due to the limited number of studies in oculoplastic surgery. This review summarizes evidence-based recommendations from related medical specialties and provides context for surgeons to tailor antithrombotic medication management based on patient's individual risk. The decision to continue or cease antithrombotic medications prior to surgery requires a careful understanding of risk: risk of intraoperative or postoperative bleeding versus risk of a perioperative thromboembolic event. Cessation and resumption of antithrombotic medications after surgery should always be individualized based on the patient's thrombotic risk, surgical and postoperative risk of bleeding, and the particular drugs involved, in conjunction with the prescribing doctors. In general, we recommend that high thromboembolic risk patients undergoing high bleeding risk procedures (orbital or lacrimal surgery) may stop antiplatelet agents, direct oral anticoagulants, and warfarin including bridging warfarin with low-molecular weight heparin. Low-risk patients, regardless of type of procedure performed, may stop all agents. Decision on perioperative management of antithrombotic medications should be made in conjunction with patient's internist, cardiologist, hematologist, or other involved physicians which may limit the role of guidelines depending on patient risk and should be used on a case-by-case basis. Further studies are needed to provide oculofacial-specific evidence-based guidelines.

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“…For warfarin, it is considered safe to operate if the INR is between 2 and 3.5 28 . Investigations of the novel oral anticoagulant agents (NOACs) including dabigatran, apixaban, and rivaroxaban have also demonstrated low hemorrhagic complication rates similar to those of traditional oral agents, and no severe or life‐threatening hemorrhagic complications 21,29,30 . At the current time, guidelines suggest continuing NOAC agents for dermatologic surgery 31,32 .…”

Section: Hemorrhagementioning

confidence: 99%

Complications of cutaneous surgery

Rothstein

Cohen²

2020

Dermatological Reviews

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Background Cutaneous surgery is associated with multiple complications including hemorrhage, surgical site infection, necrosis, and scarring. As demand for dermatologic surgery rises, it is imperative that dermatologists have a comprehensive understanding of the potential surgical risks to enhance patient safety and outcomes. Aims The purpose of this review is to highlight the rates, prevention, and management of common complications associated with cutaneous surgery, with a focus on scalpel‐based surgeries including Mohs micrographic surgery and standard surgical excision. Material and Methods Articles from PubMed are highlighted and our clinical experience is presented. Results Cutaneous surgery is overall safe and associated with low rates of complications that are predominantly minor and not life‐threatening. Prevention and management strategies vary according to the specific complication being addressed. Discussion Dermatologists should be familiar with the complications of cutaneous surgery. As our knowledge of surgical complications expands, the outcomes of our patients will continue to improve.

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Perioperative complications with new oral anticoagulants dabigatran, apixaban, and rivaroxaban in Mohs micrographic surgery: A retrospective study

Cited by 21 publications

References 5 publications

Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery—A prospective observational study

Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery—A prospective observational study

Perioperative Considerations for Antithrombotic Therapy in Oculofacial Surgery: A Review of Current Evidence and Practice Guidelines

Complications of cutaneous surgery

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