Mohs Micrographic Surgery: Key Pharmacologic Considerations

Area of Science:

• Dermatology
• Cardiology
• Pharmacology

Background:

• Mohs micrographic surgery is a specialized dermatologic procedure.
• Atrial fibrillation (Afib) management requires careful consideration of anticoagulation therapy.
• Direct oral anticoagulants (DOACs) are commonly used for stroke prevention in Afib.

Purpose of the Study:

• To evaluate the risks and benefits of withholding direct oral anticoagulants (DOACs) in patients with atrial fibrillation (Afib) undergoing Mohs micrographic surgery.
• To determine appropriate antibiotic prophylaxis for patients with Afib undergoing Mohs surgery.

Main Methods:

• Literature review on therapeutic issues in Afib patients undergoing dermatologic surgery.
• Assessment of bleeding risk with DOAC continuation versus thromboembolic risk with DOAC discontinuation.
• Evaluation of antibiotic prophylaxis guidelines for Mohs surgery in Afib patients.

Main Results:

• Continuing DOACs in Afib patients for Mohs surgery presents a low bleeding risk.
• Discontinuing DOACs in Afib patients for Mohs surgery significantly increases the risk of thromboembolic events, such as stroke.
• Pharmacist evaluation of individual patient risks is crucial.

Conclusions:

• The risk of thromboembolic events outweighs the bleeding risk when DOACs are continued for Mohs surgery in Afib patients.
• Antibiotic prophylaxis is essential to prevent surgical site infections.
• Individualized patient assessment by a pharmacist is recommended to optimize management.