Antiplatelets and Anticoagulants in Dermatological Surgery. A Protocol for Clinical Practice
Abstract
The increasing number of patients undergoing antithrombotic therapy and a higher prevalence of skin neoplasia implies an adequate management of these drugs in the perioperative period during dermatological surgery. The authors present and discuss the protocol for clinical practice followed in the Dermatology and Venereology Department of Centro Hospitalar Universitário São João. Suspension or maintenance of therapy with antiplatelet and/or anticoagulant drugs should be assessed individually, taking into account the patient and intervention’s bleeding risk and the degree of thrombotic risk of the patient. In these patients, local hemostatic measures are particularly relevant in the management of perioperative haemorrhage and should be thorough. The Immunohemotherapy Department provides collaboration in situations of difficult bleeding management.
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Tafur A, Douketis J. Perioperative management of anticoagulant and antiplatelet therapy. Heart. 2018;104:1461-67. doi:10.1136/heartjnl-2016-310581
Sacchetto L, Zanetti R, Comber H, Bouchardy C, Brewster DH, Broganelli P, et al. Trends in incidence of thick, thin and in situ melanoma in Europe. Eur J Cancer. 2018;92:108-18. doi:10.1016/j.ejca.2017.12.024
Iyengar S, Yeager DG, Cohen JL, Ozog DM. Update and Review of Bleeding Considerations in Dermatologic Surgery: Anticoagulants and Antiplatelets. Dermatol Surg. 2020;46:192-201. doi:10.1097/DSS.0000000000002266
Brinca A, Pinto Gouveia M, Vieira R. Antiplatelet and anticoagulant therapyin dermatological surgery- clinical practice recomendations. J Port Soc Dermatology Venereol. 2015;73:427-37.
Doherty JU, Gluckman TJ, Hucker WJ, Januzzi JL Jr, Ortel TL, Saxonhouse SJ, et al. 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation: A Report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol. 2017;69:871-98. doi:10.1016/j.jacc.2016.11.024
Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-Vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;39:1330-93. doi:10.1093/eurheartj/ehy136
Martins R, Lopes S, Fraga C, Gonçalves L. Gestão de doentes hipocoagulados na prática clínica no servico de estomatologia do Centro Hospitalar Universitário de S. João. Rev Assoc Médicos Estomatol Port. 2019;16:10-14.
Sporbeck B, Georges Bechara F, Häfner HM, Koenen W, Kolk A, Koscielny J, et al. S3 guidelines for the management of anticoagulation in cutaneous surgery. J Dtsch Dermatol Ges. 2015;13:346-56. doi: 10.1111/ddg.12576.
Bray A. British Society for Dermatological Surgery Guidance on Antithrombotics and Skin Surgery. Br Soc Dermatologists. [accessed Dec 2020 ] Available from: https://bsds.org.uk/resources/bsds-bad-guidelines/
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:e326S-e350S. doi:10.1378/chest.11-2298
Previtali E, Bucciarelli P, Passamonti SM, Martinelli I. Risk factors for venous and arterial thrombosis. Blood Transfus. 2011;9:120-38. doi:10.2450/2010.0066-10
January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Hear Rhythm. 2019;16:e66-e93. doi:10.1016/j.hrthm.2019.01.024
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42:373-498. doi:10.1093/eurheartj/ehaa612
Straith RE, Raju DR, Hipps CJ. The study of hematomas in 500 consecutive face lifts. Plast Reconstr Surg. 1977;59:694-8. doi:10.1097/00006534-197705000-00012
Bunick CG, Aasi SZ. Hemorrhagic complications in dermatologic surgery. Dermatol Ther. 2011;24:537-50. doi:10.1111/j.1529-8019.2012.01454.x
Salem RO, Laposata M. Effects of alcohol on hemostasis. Am J Clin Pathol. 2005;123 Suppl. doi:10.1309/113n8eufxyueccn
Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood. 2012;120:2954-62. doi:10.1182/blood-2012-06-415943
Fonseca C, Alves J, Araújo F. Peri-Operative Management of Antithrombotic Agents: Results of the 3rd Consensus Meeting of the Portuguese Society of Anesthesiology. Rev Port Soc Anestesiol.2014; 23
Dornbos D, Nimjee SM. Reversal of Systemic Anticoagulants and Antiplatelet Therapeutics. Neurosurg Clin N Am. 2018;29:537-45. doi:10.1016/j.nec.2018.06.005
Tomaselli GF, Mahaffey KW, Cuker A, Dobesh PP, Doherty JU, Eikelboom JW, et al. 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020;76:594-622.
doi:10.1016/j.jacc.2020.04.053
Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373:823-833. doi:10.1056/NEJMoa1501035.
Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schünemann HJ. Executive summary: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:7S-47S. doi:10.1378/chest.1412S
Shimizu I, Jellinek NJ, Dufresne RG, Li T, Devarajan K, Perlis C. Multiple antithrombotic agents increase the risk of postoperative hemorrhage in dermatologic surgery. J Am Acad Dermatol. 2008;58:810-6. doi:10.1016/j.jaad.2008.01.014
Robinson J, Hanke CW, Siegel DM, Fratila A. Surgery of the Skin: Procedural Dermatology. Amsterdam: Mosby-Elsevier; 2010.
Nguyen T-M-U, La Caze A, Cottrell N. Validated adherence scales used in a measurement-guided medication management approach to target and tailor a medication adherence intervention: a randomised controlled trial. BMJ Open. 2016;6:e013375. doi:10.1136/bmjopen-2016-013375
Fischer D, Orlando P, Shane-McWhorter L. Mohs micrographic surgery: Key pharmacologic considerations. Consult Pharm. 2017;32:450-7. doi:10.4140/TCP.n.2017.450
Rizk C, Monroe H, Orengo I, Rosen T. Needlestick and sharps injuries in dermatologic surgery: A review of preventative techniques and post-exposure protocols. J Clin Aesthet Dermatol. 2016;9:41-9.
Cook JL, Perone JB. A prospective evaluation of the incidence of complications associated with Mohs micrographic surgery. Arch Dermatol. 2003;139:143-152. doi:10.1001/archderm.139.2.143
Singer AJ, Dagum AB. Current management of acute cutaneous wounds. N Engl J Med. 2008;359:1037-46. doi:10.1056/NEJMra0707253
Achneck HE, Sileshi B, Jamiolkowski RM, Albala DM, Shapiro ML, Lawson JH. A comprehensive review of topical hemostatic agents: Efficacy and recommendations for use. Ann Surg. 2010;251:217-28. doi:10.1097/SLA.0b013e3181c3bcca
Al-Mubarak L, Al-Haddab M. Cutaneous wound closure materials: An overview and update. J Cutan Aesthet Surg. 2013;6:178. doi:10.4103/0974-2077.123395
Billingsley EM, Maloney ME. Intraoperative and postoperative bleeding problems in patients taking warfarin, aspirin, and nonsteroidal antiinflammatory agents: A prospective study. Dermatologic Surg. 1997;23:381-83. doi:10.1111/j.1524-4725.1997.tb00065.x
Hornor MA, Duane TM, Ehlers AP, Jensen EH, Brown PS Jr, Pohl D, et al. American College of Surgeons’ Guidelines for the Perioperative Management of Antithrombotic Medication. J Am Coll Surg. 2018;227:521-36.e1. doi:10.1016/j.jamcollsurg.2018.08.183
Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The Euro Heart Survey on atrial fibrillation. Chest. 2010;137:263-72. doi:10.1378/chest.09-1584
Gherli R, Mariscalco G, Dalén M, Onorati F, Perrotti A, Chocron S, et al. Safety of preoperative use of ticagrelor with or without aspirin compared with aspirin alone in patients with acute coronary syndromes undergoing coronary artery bypass grafting. JAMA Cardiol. 2016;1:921-8. doi:10.1001/jamacardio.2016.3028
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