Update and Review of Bleeding Considerations in Dermatologic Surgery: Anticoagulants and Antiplatelets
Sanjana Iyengar1, Danielle G Yeager2, Joel L Cohen3,4
1Department of Dermatology, West Virginia University, Morgantown, West Virginia.
Insights
Dermatologic surgery carries bleeding risks, especially for patients on anticoagulant or antiplatelet therapy. Continued use is generally advised, but novel oral anticoagulants require caution due to limited data.
Area of Science:
- Dermatology
- Pharmacology
- Surgical Oncology
Background:
- Bleeding is an inherent risk in dermatologic surgery.
- Patients on hemostasis-affecting agents may face elevated bleeding risks.
Purpose of the Study:
- To review current anticoagulant and antiplatelet therapies.
- To assess bleeding complication risks in cutaneous surgery associated with these agents.
Main Methods:
- Systematic review of English-language literature.
- Searches conducted on PubMed and MEDLINE databases.
Main Results:
- Multiple anticoagulant and antiplatelet therapies are available.
- Perioperative continuation of these agents is often recommended.
- Combination therapies and novel oral anticoagulants may increase bleeding risk.
Conclusions:
- Understanding antiplatelet and anticoagulant agents is crucial for surgeons.
- Discontinuation is not typically supported perioperatively.
- Novel oral anticoagulants necessitate a cautious approach due to sparse data.
Background:
Bleeding is an unavoidable risk of dermatologic surgery. The risk may be higher in patients taking agents that affect hemostasis.
Objective:
The aim of this study was to provide an updated review of current anticoagulant and antiplatelet therapy available in the market and their associated risk of bleeding complications in cutaneous surgery.
Materials And Methods:
A review of PubMed and MEDLINE was performed to review the English-language medical literature.
Results:
Many anticoagulant and antiplatelet therapies exist. Several studies recommend the continued use of antiplatelet and anticoagulant medications in the perioperative period. Combination regimens and novel oral anticoagulants may be associated with an increased risk of bleeding.
Conclusion:
An updated understanding of antiplatelet and anticoagulant agents is critical for the surgeon. Current evidence does not support the discontinuation of antiplatelet and anticoagulant agents in the perioperative period under most circumstances. However, relevant data on novel oral anticoagulant agents are still sparse, suggesting that a precautionary approach is warranted.
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