Complications With New Oral Anticoagulants Dabigatran and Rivaroxaban in Cutaneous Surgery

Abstract

Because no patients on dabigatran or rivaroxaban experienced severe hemorrhagic complications during cutaneous surgery, a strategy of continuing these medically necessary medications during cutaneous surgery seems reasonable.

Perioperative complications with new oral anticoagulants dabigatran, apixaban, and rivaroxaban in Mohs micrographic surgery: A retrospective study

“…The rationale for this is based on data from several peer-reviewed studies showing that the risk of hemorrhagic complications, dehiscence, or infection was not increased in patients taking anticoagulants compared with in controls. 1,4 Likewise, our findings did not show a significant difference in the rate of complications in patients taking NOACs compared with in all other patients who underwent MMS during the same period at this institution. The bleeding complication rate was 1.3% for patients receiving NOACs versus 0.7% for all other patients, and the infection rates were 2.6% and 1.1% respectively.…”

“…To the Editor: Mohs micrographic surgery (MMS) has been reported to be safe, with a low incidence of adverse effects both intraoperatively and postoperatively. 1 Approximately 25% to 38% of patients who undergo cutaneous surgery are taking an antithrombotic agent that puts them at a slightly higher risk for bleeding. 2 Novel oral anticoagulants (NOACs) are an increasing presence in the dermatologist's office, as head-to-head clinical trials have shown them to have efficacy equal to superior that of warfarin.…”

“…Furthermore, temporary discontinuation of anticoagulants has not been shown to reduce the risk for hemorrhagic complications compared with in controls or in those who continued to take them. 1,3,4 Continuing the use of warfarin and NOACs to avoid potentially lethal thromboembolic complications is considered the most appropriate option. [1][2][3][4] Although there are no previous data 4,5 Although many studies have examined the prevalence of individual tanning modalities, little is known about how people combine tanning modalities.…”

Complications of cutaneous surgery

“…For warfarin, it is considered safe to operate if the INR is between 2 and 3.5 28 . Investigations of the novel oral anticoagulant agents (NOACs) including dabigatran, apixaban, and rivaroxaban have also demonstrated low hemorrhagic complication rates similar to those of traditional oral agents, and no severe or life‐threatening hemorrhagic complications 21,29,30 . At the current time, guidelines suggest continuing NOAC agents for dermatologic surgery 31,32 .…”

To Maintain or Cease Non–Vitamin K Antagonist Oral Anticoagulants Prior to Minimal Bleeding Risk Procedures: A Review of Evidence and Recommendations

“…A retrospective review at a single center reported outcomes of 27 patients on dabigatran who underwent 41 cutaneous surgeries (Mohs micrographic surgery or basic excision) and 4 patients on rivaroxaban who underwent 5 cutaneous surgeries. 34 NOACs were continued in all patients. No hemorrhagic complications were observed in the rivaroxaban group, while one patient (3.7%) on dabigatran developed postoperative bleeding that was controlled with a pressure dressing.…”