Mohs y Anticoagulantes

Published in Dermatology

Journal Scan / Research · June 24, 2020

Postoperative Bleeding Complications Associated With Blood Thinning Agents During Mohs Micrographic Surgery

Journal of the American Academy of Dermatology

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• In this study, 2732 cases of Mohs micrographic surgery (MMS) were reviewed for association of postoperative bleeding with anticoagulant therapy. Overall, 28 (1.0%) of cases were complicated by postoperative bleeding. In patients taking warfarin or clopidogrel, bleeding events occurred in 1/78 (1.3%) and 1/37 (2.7%), respectively. Among those taking newer anticoagulants such as direct thrombin inhibitors or factor Xa inhibitors, 1/114 (0.9%) developed postoperative bleeding. There was no significant increase in bleeding events in any of these groups compared with patients on no anticoagulants.

• This study supports a very low risk of postoperative bleeding in patients on anticoagulants, including newer anticoagulants, after MMS. Medically indicated anticoagulants should be continued during MMS.

– Margaret Hammond, MD

abstract

This abstract is available on the publisher's site.

Mohs micrographic surgery (MMS) is a safe, office-based procedure with low complication rates, of which, bleeding is among the most common1. Several new pharmacotherapies have been developed to decrease thrombotic events, with limited data on their risks during cutaneous surgery. Common antithrombotic agents include aspirin, clopidogrel, warfarin, direct thrombin inhibitors, factor Xa inhibitors, and dual antiplatelet therapy. Aspirin has not been associated with increased bleeding in cutaneous surgery,1-5 while monotherapy with warfarin or clopidogrel has a low increased bleeding risk.2-5 Most studies conclude that discontinuation of antiplatelet or anticoagulant therapy is not recommended.1-5 A series of small studies did not show a significantly increased bleeding rate on Factor Xa inhibitors or direct thrombin inhibitors during cutaneous surgery and MMS.3,5 To date, no large studies have investigated postoperative bleeding in patients taking combinations of anticoagulants4. We hypothesize that patients taking newer, or multiple anticoagulants do not have a greater risk of bleeding.

Copyright © 2020 Elsevier Inc. All rights reserved.

Journal of the American Academy of Dermatology

Postoperative Bleeding Complications Associated With Blood Thinning Agents During Mohs Micrographic Surgery: A Retrospective Cohort Study

J Am Acad Dermatol 2020 Jun 08;[EPub Ahead of Print], O Taylor, C Carr, C Greif, A Garcia, S Tran, D Srivastava, RI Nijhawan