Perioperative anticoagulation recommendations for cutaneous oncologic surgery: a review of the literature

Consistent perioperative management is important to the practice of dermatologic surgery. With the widespread use of anticoagulant medications, such as aspirin, warfarin, clopidogrel, factor Xa inhibitors, and thrombin inhibitors for a number of cardiovascular indications, it is important to standardize the use of these drugs in the setting of skin cancer surgery. Limited literature is available, however, regarding recommendations for dermatological perioperative anticoagulation management. Most published manuscripts involving anticoagulation and skin cancer surgery focus on complications and outcomes rather than providing guidelines for decision-making. In addition, survey studies have largely shown that even with existing recommendations in the literature, many dermatologists continue to have varying management of these medications. Overall, this review finds compelling evidence to support the safety of continuing anticoagulation therapy, such as warfarin, aspirin, and clopidogrel throughout treatment for cutaneous malignancies. It is important that dermatologists, while having primary care and cardiology available for consultation, are aware of the safety data and feel comfortable managing their patients perioperatively.