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Cutaneous surgery in patients receiving warfarin therapy.
1Mohs Surgery Unit, Assuta Medical Center, Tel Aviv, Israel. alcalays@inter.net.il
Summary
Continuing warfarin (Coumadin) during cutaneous surgery is safe and effective. This approach prevents dangerous blood clots (thromboembolisms) without increasing bleeding risks in patients undergoing procedures like Mohs surgery.
Area of Science:
- Dermatologic Surgery
- Cardiology
- Pharmacology
Background:
- Warfarin (Coumadin) is crucial for preventing thromboembolisms in patients with prosthetic heart valves and atrial fibrillation.
- The necessity of discontinuing warfarin before cutaneous surgery remains a subject of debate.
Purpose of the Study:
- To assess the outcomes of excisional and Mohs surgeries in patients continuing warfarin therapy.
- To evaluate perioperative bleeding and cosmetic results in this patient cohort.
Main Methods:
- Warfarin therapy was maintained throughout excisional and Mohs surgeries for all patients from November 1999 to November 2000.
- Perioperative complications, including bleeding and cosmetic results, were systematically recorded.
- A control group of 77 patients not on warfarin was included for comparison.
Main Results:
- A total of 1090 patients underwent surgery (560 Mohs, 530 excisional).
- Sixteen patients (1.5%) were on warfarin with therapeutic International Normalized Ratio (INR) values.
- No intraoperative or postoperative bleeding complications were observed; all wounds healed successfully, including grafts.
Conclusions:
- Continued warfarin (Coumadin) treatment is recommended for patients undergoing cutaneous surgery.
- Maintaining anticoagulation minimizes the risk of thromboembolic events without compromising surgical outcomes.