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National Survey on Antithrombotic Management in Minor Hand Surgery.

Justin Haas1, James Douketis2, Forough Farrokhyar3

  • 1Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

The Journal of Hand Surgery
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Summary

Many surgeons hold antithrombotic medications for minor hand surgeries, despite guidelines recommending continuation. This practice varies, especially with anticoagulants like apixaban and warfarin, potentially increasing patient risks.

Keywords:
Antithrombotic managementbleeding risk assessmentclinical practice variationminor hand surgeryperioperative anticoagulation

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Area of Science:

  • Surgical Management
  • Pharmacology
  • Patient Safety

Background:

  • Withholding antithrombotic medications during surgery increases thromboembolic risk.
  • Minor hand surgeries frequently involve patients on antithrombotic therapy, necessitating careful perioperative management.
  • Existing guidelines offer recommendations for managing antithrombotic therapy around surgical procedures.

Purpose of the Study:

  • To assess current pre-procedural antithrombotic management strategies used by hand surgeons for minor hand surgeries.
  • To evaluate the adherence of hand surgeons' practices to established clinical practice guidelines for antithrombotic management.

Main Methods:

  • A 2024 cross-sectional, descriptive study utilized an electronic survey distributed to Canadian hand surgeons.
  • Surgeons were surveyed on their general practices and specific decisions regarding holding antithrombotic medications for theoretical minor hand surgery cases (soft tissue excision, trigger finger release, carpal tunnel release).

Main Results:

  • Seventy-four surgeons participated; 93.7% perceived minor hand procedures as low bleeding risk, though this perception decreased for specific anticoagulants (apixaban 71.2%, warfarin 59.9%).
  • Significant proportions of surgeons reported holding medications: aspirin (26.6%), warfarin (37.8%), and apixaban (47.7%).
  • Holding antithrombotic medications was associated with being a non-hand surgeon and consulting hematology specialists.

Conclusions:

  • Substantial variation exists in perioperative antithrombotic management for minor hand surgeries, with many surgeons holding medications contrary to guidelines for low-risk procedures.
  • Perception of bleeding risk varies with anticoagulant type, impacting management decisions.
  • Improved dissemination and adherence to evidence-based guidelines are needed to standardize care and optimize outcomes in antithrombotic management for minor hand surgery.