The management of antithrombotic medication in skin surgery

Shields Callahan, Anne Goldsberry*, Glen Kim, Simon S Yoo

*Corresponding author for this work

Research output: Contribution to journalReview article

29 Citations (Scopus)

Abstract

Background: Approximately one in four patients undergoing dermatologic surgery takes an antithrombotic medication. When approaching the management of antithrombotic agents, procedural dermatologists must balance surgical outcomes, bleeding risks, and cardiovascular protection. Continuing antithrombotics during surgery increases the risk hemorrhage, but discontinuation of these agents may increase the risk of thrombotic events. Despite increasing evidence for continuation of antithrombotics during dermatologic surgery, few official guidelines exist, and clinicians have been slow to integrate new evidence into clinical practice. A study in 2007 reported that more than 40% of dermatologic surgeons sometimes discontinue warfarin for surgery. Objective: This article reviews antithrombotic agents in the United States and summarize perioperative management recommendations of antithrombotic agents in skin surgery. Materials and Methods: A review of the literature was performed focused on antithrombotic medications commercially available in the United States, including the two newest agents, dabigatran and rivaroxaban. Conclusion Although there are concerns regarding bleeding, there are no reports of life-threatening hemorrhage from continued antithrombotic therapy in dermatologic surgery. Furthermore, potentially fatal cardiovascular events after cessation of medically indicated antithrombotic medications are increasingly recognized, leading to the growing acceptance that the risk of stopping most antithrombotics may outweigh the risks of bleeding incurred by continuing antithrombotic therapy.

Original languageEnglish (US)
Pages (from-to)1417-1426
Number of pages10
JournalDermatologic Surgery
Volume38
Issue number9
DOIs
StatePublished - Sep 1 2012

Fingerprint

Dermatologic Surgical Procedures
Fibrinolytic Agents
Hemorrhage
Warfarin
Guidelines
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Dermatology

Cite this

Callahan, Shields ; Goldsberry, Anne ; Kim, Glen ; Yoo, Simon S. / The management of antithrombotic medication in skin surgery. In: Dermatologic Surgery. 2012 ; Vol. 38, No. 9. pp. 1417-1426.
@article{c28aea1f00884886bf96c50c5e616b60,
title = "The management of antithrombotic medication in skin surgery",
abstract = "Background: Approximately one in four patients undergoing dermatologic surgery takes an antithrombotic medication. When approaching the management of antithrombotic agents, procedural dermatologists must balance surgical outcomes, bleeding risks, and cardiovascular protection. Continuing antithrombotics during surgery increases the risk hemorrhage, but discontinuation of these agents may increase the risk of thrombotic events. Despite increasing evidence for continuation of antithrombotics during dermatologic surgery, few official guidelines exist, and clinicians have been slow to integrate new evidence into clinical practice. A study in 2007 reported that more than 40{\%} of dermatologic surgeons sometimes discontinue warfarin for surgery. Objective: This article reviews antithrombotic agents in the United States and summarize perioperative management recommendations of antithrombotic agents in skin surgery. Materials and Methods: A review of the literature was performed focused on antithrombotic medications commercially available in the United States, including the two newest agents, dabigatran and rivaroxaban. Conclusion Although there are concerns regarding bleeding, there are no reports of life-threatening hemorrhage from continued antithrombotic therapy in dermatologic surgery. Furthermore, potentially fatal cardiovascular events after cessation of medically indicated antithrombotic medications are increasingly recognized, leading to the growing acceptance that the risk of stopping most antithrombotics may outweigh the risks of bleeding incurred by continuing antithrombotic therapy.",
author = "Shields Callahan and Anne Goldsberry and Glen Kim and Yoo, {Simon S}",
year = "2012",
month = "9",
day = "1",
doi = "10.1111/j.1524-4725.2012.02490.x",
language = "English (US)",
volume = "38",
pages = "1417--1426",
journal = "Dermatologic Surgery",
issn = "1076-0512",
publisher = "Wiley-Blackwell",
number = "9",

}

The management of antithrombotic medication in skin surgery. / Callahan, Shields; Goldsberry, Anne; Kim, Glen; Yoo, Simon S.

In: Dermatologic Surgery, Vol. 38, No. 9, 01.09.2012, p. 1417-1426.

Research output: Contribution to journalReview article

TY - JOUR

T1 - The management of antithrombotic medication in skin surgery

AU - Callahan, Shields

AU - Goldsberry, Anne

AU - Kim, Glen

AU - Yoo, Simon S

PY - 2012/9/1

Y1 - 2012/9/1

N2 - Background: Approximately one in four patients undergoing dermatologic surgery takes an antithrombotic medication. When approaching the management of antithrombotic agents, procedural dermatologists must balance surgical outcomes, bleeding risks, and cardiovascular protection. Continuing antithrombotics during surgery increases the risk hemorrhage, but discontinuation of these agents may increase the risk of thrombotic events. Despite increasing evidence for continuation of antithrombotics during dermatologic surgery, few official guidelines exist, and clinicians have been slow to integrate new evidence into clinical practice. A study in 2007 reported that more than 40% of dermatologic surgeons sometimes discontinue warfarin for surgery. Objective: This article reviews antithrombotic agents in the United States and summarize perioperative management recommendations of antithrombotic agents in skin surgery. Materials and Methods: A review of the literature was performed focused on antithrombotic medications commercially available in the United States, including the two newest agents, dabigatran and rivaroxaban. Conclusion Although there are concerns regarding bleeding, there are no reports of life-threatening hemorrhage from continued antithrombotic therapy in dermatologic surgery. Furthermore, potentially fatal cardiovascular events after cessation of medically indicated antithrombotic medications are increasingly recognized, leading to the growing acceptance that the risk of stopping most antithrombotics may outweigh the risks of bleeding incurred by continuing antithrombotic therapy.

AB - Background: Approximately one in four patients undergoing dermatologic surgery takes an antithrombotic medication. When approaching the management of antithrombotic agents, procedural dermatologists must balance surgical outcomes, bleeding risks, and cardiovascular protection. Continuing antithrombotics during surgery increases the risk hemorrhage, but discontinuation of these agents may increase the risk of thrombotic events. Despite increasing evidence for continuation of antithrombotics during dermatologic surgery, few official guidelines exist, and clinicians have been slow to integrate new evidence into clinical practice. A study in 2007 reported that more than 40% of dermatologic surgeons sometimes discontinue warfarin for surgery. Objective: This article reviews antithrombotic agents in the United States and summarize perioperative management recommendations of antithrombotic agents in skin surgery. Materials and Methods: A review of the literature was performed focused on antithrombotic medications commercially available in the United States, including the two newest agents, dabigatran and rivaroxaban. Conclusion Although there are concerns regarding bleeding, there are no reports of life-threatening hemorrhage from continued antithrombotic therapy in dermatologic surgery. Furthermore, potentially fatal cardiovascular events after cessation of medically indicated antithrombotic medications are increasingly recognized, leading to the growing acceptance that the risk of stopping most antithrombotics may outweigh the risks of bleeding incurred by continuing antithrombotic therapy.

UR - http://www.scopus.com/inward/record.url?scp=84866421077&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866421077&partnerID=8YFLogxK

U2 - 10.1111/j.1524-4725.2012.02490.x

DO - 10.1111/j.1524-4725.2012.02490.x

M3 - Review article

VL - 38

SP - 1417

EP - 1426

JO - Dermatologic Surgery

JF - Dermatologic Surgery

SN - 1076-0512

IS - 9

ER -