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Mohs Micrographic Surgery: Key Pharmacologic Considerations.

Diana Fischer¹, Patricia Orlando, Laura Shane-McWhorter

¹Intermountain Healthcare, Taylorsville, Utah, USA.

The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists

|October 15, 2017

Summary

For patients with atrial fibrillation (Afib) undergoing Mohs surgery, continuing direct oral anticoagulants poses a low bleeding risk but a high thromboembolic risk. Antibiotic prophylaxis is recommended to prevent infection.

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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.

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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.