Elective Hand Surgery and Antithrombotic Use in Veterans.

Area of Science:

• Plastic Surgery
• Vascular Surgery
• Geriatric Medicine

Background:

• Traditionally, anticoagulants and antiplatelets are stopped before plastic surgery to prevent bleeding.
• Veterans often require anticoagulants for critical embolic and thrombotic event prevention.
• A shift in practice allowed elective hand surgery patients to continue anticoagulants perioperatively.

Purpose of the Study:

• To evaluate the postoperative bleeding complication rate in patients who continued prescription anticoagulants during elective hand surgery.
• To assess the safety of maintaining anticoagulation in this patient population over a 7.5-year period.

Main Methods:

• Retrospective review of health records at Malcom Randall Veterans Affairs Medical Center (January 2015–June 2022).
• Identification of elective hand surgery cases, including carpal tunnel decompression, trigger finger release, and others.
• Analysis of patient records for anticoagulant use and postoperative bleeding complications within 30 days.

Main Results:

• 178 patients continued anticoagulants during elective hand surgery.
• One major bleeding complication (0.6%) required reoperation (cubital tunnel release on clopidogrel and aspirin).
• Four minor bleeding complications (2.2%) were managed conservatively.

Conclusions:

• Continuing anticoagulants and antiplatelets perioperatively for elective hand surgery is a safe practice.
• The local complication rate associated with continuing these medications is acceptably low.
• This approach supports improved patient care by avoiding unnecessary medication cessation.