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Complications of cutaneous surgery in patients taking clopidogrel-containing anticoagulation

Robert H Cook-Norris1, Jason D Michaels2, Amy L Weaver3

  • 1Department of Dermatology, Mayo Clinic, Rochester, Minnesota.

Journal of the American Academy of Dermatology
|April 26, 2011
PubMed
Abstract

Insights

Patients taking clopidogrel for anticoagulation face a higher risk of severe complications during cutaneous surgery. This risk is significantly elevated compared to aspirin or no anticoagulation, particularly for larger surgical sites.

Area of Science:

  • Dermatology
  • Cardiology
  • Surgical Oncology

Background:

  • Most anticoagulants do not increase severe complications during cutaneous surgery.
  • Limited data exists on clopidogrel's association with surgical complications.

Purpose of the Study:

  • To determine the frequency and severity of perioperative complications in patients undergoing cutaneous surgery while on clopidogrel-containing anticoagulation.
  • To compare complication rates between clopidogrel users, aspirin monotherapy users, and non-anticoagulated patients.

Main Methods:

  • Retrospective review of medical records of patients undergoing Mohs micrographic surgery.
  • Comparison of patients on clopidogrel-containing anticoagulation with control groups on aspirin monotherapy or no anticoagulation.
  • Data collected between 2004 and 2008 at Mayo Clinic, Rochester, MN.

Main Results:

  • Clopidogrel-containing anticoagulation was associated with a significantly higher risk of severe complications (28x vs. no anticoagulation, 6x vs. aspirin monotherapy).
  • Patients on both clopidogrel and aspirin had an 8x higher risk of severe complications compared to aspirin monotherapy.
  • Larger postoperative surgical sites were linked to a higher likelihood of severe complications.

Conclusions:

  • Cutaneous surgery in patients on clopidogrel-containing anticoagulation is linked to an increased risk of severe, non-life-threatening complications.
  • Limitations include the retrospective design, potential recall bias, and a small number of severe complications.
  • No thrombotic complications occurred upon discontinuation of clopidogrel; one occurred with regimen modification.

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