Elective Hand Surgery and Antithrombotic Use in Veterans

Patients undergoing plastic surgery have traditionally been instructed to avoid anticoagulants and antiplatelets during the perioperative period to avoid bleeding that could lead to painful hematomas, skin necrosis, unplanned procedures, and blood transfusions. Many veterans are currently prescribed anticoagulants for prevention of life- and limb-threatening embolic and thrombotic events. In early 2015, the plastic surgery service began to instruct patients undergoing elective hand surgery to stay on their prescription anticoagulant perioperatively. The objective of this study was to determine the postoperative bleeding complication rate, if any, over a 7.5-year period in patients who did not interrupt their prescription anticoagulants.

Health records at the Malcom Randall Veterans Affairs Medical Center in Gainesville, Florida, were queried for all plastic surgery cases performed from January 1, 2015, through June 30, 2022. Elective hand cases were identified based on the operation description and included carpal tunnel decompression (endo and open), cubital tunnel decompression (in situ), trigger finger release, trapeziectomy, small-joint fusion, neurectomy, elective amputations, and benign neoplasm removals. Patient history and physicals notes were reviewed for mention of a prescription anticoagulant on their medication list and for instructions to not discontinue blood thinner use. The postoperative notes were reviewed for up to 30 days to look for evidence of postoperative bleeding complications.

One hundred seventy-eight patients were identified for maintaining prescription blood thinners during their elective hand surgery. There was 1 major complication (0.6%) when a patient had to return to surgery for emergent control of bleeding. This was an in situ cubital tunnel release on clopidogrel and aspirin. There were 4 minor bleeding complications (2.2%) that were treated in the clinic with compression, wound care, or expedited follow-up for reassurance.

Continuing prescription anticoagulants and antiplatelets during the perioperative period for elective hand surgery is a safe practice with an acceptably low local complication rate.