Part 2: Management of intraoperative and perioperative bleeding

With an increase in number of patients on antithrombotic therapies, management of bleeding during dermatologic surgery is increasingly important. As described in Part 1, perioperative discontinuation of antithrombotic therapies may increase the risk of embolic events thus the risks and benefits must be weighed carefully when deciding whether to continue or suspend therapy. However, continuing oral anticoagulants may result in increased intraoperative and postoperative bleeding. Here we describe various methods to effectively achieve hemostasis which include (1) mechanical methods to compress the vasculature, (2) pharmacologic agents that induce vasoconstriction, (3) physiologic agents that augment clot formation, and (4) physical agents that promote platelet aggregation.