ANTIAGREGANTES E ANTICOAGULANTES EM CIRURGIA DERMATOLÓGICA – NORMAS DE ORIENTAÇÃO CLÍNICA

Ana Brinca; Miguel Pinto Gouveia; Ricardo Vieira

doi:10.29021/spdv.73.4.483

Ana Brinca Assistente Hospitalar de Dermatologia e Venereologia/Consultant, Dermatology and Venereology, Serviço de Dermatologia;Dermatology Department, Unidade de Cirurgia Dermatológica/Dermatologic Surgery Unit, Centro Hospitalar Universitário de Coimbra/Coimbra Hospital and Universitary Centre
Miguel Pinto Gouveia Médico Interno de Dermatologia e Venereologia/Resident of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra/Coimbra Hospital and Universitary Centre
Ricardo Vieira Professor Auxiliar de Dermatologia/Assistant Professor of Dermatology, Faculdade de Medicina da Universidade de Coimbra/Faculty of Medicine University of Coimbra, Portugal

DOI: https://doi.org/10.29021/spdv.73.4.483

Palavras-chave: Anticoagulantes, Antiagregantes Plaquetares, Padrões na Prática dos Médicos, Procedimentos Cirúrgicos dermatológicos

Resumo

Introdução: A abordagem da terapêutica antitrombótica não é consensual na cirurgia dermatológica. O dermatologista tem de ponderar entre o risco hemorrágico e o risco trombótico quando decide do manuseio destes fármacos no período perioperatório.

Material e Métodos: Os autores reviram a literatura disponível com o intuito de elaborar normas de orientação clínica para a abordagem destes doentes.

Resultados: Há poucos estudos significativos publicados nesta área, e por vezes com diferentes abordagens e recomendações. O principal objetivo do cirurgião dermatológico deverá ser a otimização dos resultados cirúrgicos sem esquecer os riscos trombóticos e hemorrágicos inerentes ao doente e ao procedimento cirúrgico.

Conclusões: Recomendamos a continuação dos antitrombóticos nos procedimentos dermatológicos com baixo risco hemorrágico. Nos doentes com elevado risco tromboembólico recomendamos a continuação do fármaco antitrombótico nos procedimentos de baixo risco hemorrágico, e a ponderação da sua suspensão com substituição por heparina de baixo peso molecular nos procedimentos de elevado risco hemorrágico. No entanto, estas recomendações globais não se devem sobrepor a uma abordagem individualizada à situação clínica pontual de cada doente.

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