Complications With New Oral Anticoagulants Dabigatran and Rivaroxaban in Cutaneous Surgery

Heard, L. Kevin; Shanahan, Christine; Maggio, Kurt L.

doi:10.1097/dss.0000000000000956

Cited by 12 publications

(15 citation statements)

References 3 publications

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“…29,30 It has been demonstrated that the bleeding-risk might be increased by DOAC-therapy, and in some cases, even severe post-operative bleeding has been described. [31][32][33][34][35] Our study showed a rate of severe bleeding of 2.67% under api/dab and 0.79% under riv/edo, without significant difference compared to patients without AP/ AC-medication. Thus, the risk of severe bleeding was not increased under DOAC.…”

Section: Discussionmentioning

confidence: 47%

“…An interdisciplinary study with a predefined dosing regimen for DOAC showed rates of severe bleeding of 0.59% (apixaban), 0.91% (dabigatran) and 1.27% (rivaroxaban) in the overall group, but no bleeding event in the subgroup of dermatological patients 29,30 . It has been demonstrated that the bleeding‐risk might be increased by DOAC‐therapy, and in some cases, even severe post‐operative bleeding has been described 31–35 . Our study showed a rate of severe bleeding of 2.67% under api/dab and 0.79% under riv/edo, without significant difference compared to patients without AP/AC‐medication.…”

Section: Discussionmentioning

confidence: 54%

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Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery—A prospective observational study

Höper,

Rosen,

Kofler

et al. 2023

Acad Dermatol Venereol

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BackgroundPerioperative management of antiplatelet and anticoagulant (AP/AC) therapy is a matter of balancing the risks of bleeding and thromboembolic events. Reliable data for dermatosurgery are still lacking, especially for direct oral anticoagulants (DOAC).ObjectivesThe aim was to prospectively evaluate the influence of AP/AC‐medication on bleeding risk in dermatosurgery with focus on exact intervals between DOAC intake and procedure performed on post‐operative bleeding.MethodsPatients with or without AP/AC‐therapy were included in the study without randomization. Exact times of DOAC‐intake, procedure performed and post‐operative bleeding were documented. Data collection was prospectively and standardized done by one person.ResultsWe evaluated 1852 procedures in 675 patients. Post‐operative bleeding occurred after 15.93% (n = 295) of all procedures, but only a few of them were severe (1.57%, n = 29). Compared to patients without AP/AC‐medication, severe post‐operative bleeding occurred significantly more often under dual antiplatelet therapy (11.76%, n = 2; p = 0.0166) and bridging of either vitamin K antagonist (9.09%, n = 2; p = 0.0270) or DOAC (15.38%, n = 2; p = 0.0099). There was no significant difference in the frequency of severe bleeding regarding to the preoperative DOAC‐free period.ConclusionsAlthough AP/AC‐therapy is associated with a significant higher rate of post‐operative bleeding, no life‐threatening bleeding was recorded. Long preoperative pausing or bridging of DOAC does not lead to significantly less severe bleeding events.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 54%

Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery—A prospective observational study

Höper,

Rosen,

Kofler

et al. 2023

Acad Dermatol Venereol

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“…Previous studies that suggested an increased risk of bleeding related to NOACs had fewer patients on NOACs and either did not have a comparison group or failed to include patients taking no antithrombotic agents. 5,6 In contrast to patients on NOAC monotherapy, patients taking NOAC and aspirin combination therapy had an increased risk of bleeding. In addition, the risk of bleeding was elevated, although to a lesser degree, in patients taking other combinations of antithrombotic agents.…”

Section: Discussionmentioning

confidence: 99%

“…4 The current data on the risk of bleeding complications related to NOACs during MMS are limited. Small retrospective cohort studies and case series have shown mixed results, with some suggesting an increased risk of bleeding among patients taking NOACs 5,6 and others reporting a low risk. [7][8][9] The limitations of prior studies include a small number of patients on NOACs, lack of a control group, and/or no information regarding patient outcomes after bleeding events.…”

mentioning

confidence: 99%

Postoperative Bleeding Complications Associated With Novel Oral Anticoagulants in Mohs Micrographic Surgery

Fahmy,

Dowd,

Loesch

et al. 2023

Dermatol Surg

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BACKGROUND Novel oral anticoagulants (NOACs) are commonly prescribed, recently developed anticoagulants, but limited data exist on NOAC-related bleeding complications in Mohs micrographic surgery (MMS). OBJECTIVE To assess the risk of postoperative bleeding in patients taking NOACs compared with patients taking no antithrombotic medications. METHODS/MATERIALS A 5-year retrospective chart review of all MMS cases performed by a single surgeon was conducted. Patient and surgery characteristics, anticoagulant use, and bleeding complications were recorded. RESULTS Two thousand one hundred eighty-one MMS cases in 1,545 patients were included. There were 696/2,181 cases in which patients were taking at least 1 antithrombotic medication, with 149 on NOAC monotherapy and 15 on NOAC and aspirin combination therapy. Bleeding complications occurred in 22/2,181 cases. Patients on NOAC monotherapy did not have an increased risk of bleeding complications compared with patients on no antithrombotic medications (odds ratio [OR]:1.70, 95% confidence interval [CI]: 0.36–7.97, p = .50). In contrast, patients on NOAC and aspirin combination therapy exhibited an increased bleeding risk (OR: 20.5, 95% CI: 3.99–105.7, p < .001). CONCLUSION Novel oral anticoagulant use alone during MMS was not associated with an increased postoperative bleeding risk, supporting the safety of continuing NOAC therapy during MMS. However, NOAC and aspirin combination therapy was associated with a high postoperative bleeding risk. Nonetheless, these bleeding events did not lead to adverse long-term outcomes.

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“…Higher bleeding rates were observed by a separate retrospective review of 15 patients on rivaroxaban who underwent 18 Mohs micrographic surgery at a single institution. 35 Of the 18 procedures, 3 (16%) were complicated by postoperative hematomas, with 2 of the hematomas requiring rivaroxaban cessation for 4 days to control the bleeding. Despite the increased risk of bleeding observed in this study, the authors still recommended continuing patients' prescribed anticoagulant.…”

Section: Dermatologic Proceduresmentioning

confidence: 99%

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

Brennan

Favaloro

Curnow

2019

Semin Thromb Hemost

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For procedures associated with minimal bleeding risk, there are data and experience to support the practice of continuing vitamin K antagonists rather than interrupting therapy, to prevent exposing patients to the undue risk of developing thromboembolism during anticoagulation cessation. Despite the increasing use of non–vitamin K oral anticoagulants (NOACs), there is little evidence to guide the management of these drugs around minimal bleeding risk procedures. This review examines and discusses the major society guidelines and recommendations addressing the management of NOACs around minimal bleeding risk procedures. Additionally, it summarizes the existing evidence, and highlights the gaps in knowledge where evidence is not yet available. Finally, recommendations are made to assist the proceduralist deal with this area of limited evidence.

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Complications With New Oral Anticoagulants Dabigatran and Rivaroxaban in Cutaneous Surgery

Cited by 12 publications

References 3 publications

Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery—A prospective observational study

Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery—A prospective observational study

Postoperative Bleeding Complications Associated With Novel Oral Anticoagulants in Mohs Micrographic Surgery

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

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