Perioperative management of antithrombotic drugs in skin surgery – A survey of dermatologists in Germany

Abstract

Background:We identified substantial heterogeneity in the perioperative management of antithrombotic drugs in skin surgery in Germany in 2012 and 2017 in two cross-sectional surveys. The first national guideline on this subject was published in 2014 and updated in 2021. We sought to identify whether the management of these drugs had changed. Methods:We sent a paper-based survey to 1115 dermatologists throughout Germany asking them about their perioperative management of antithrombotic drugs in skin surgery, as well as their familiarity with the guideline. Results:We received responses from 65 hospital-and 202 office-based dermatologists. Most dermatologists reported continuing antithrombotic drugs in their patients when performing minor surgeries. A notable proportion of dermatologists reported discontinuing phenprocoumon treatment perioperatively and bridging patients with heparin when performing more invasive surgeries. Continuation was less common during combination therapies. Conclusions:The proportion of physicians in Germany who reported managing antithrombotic drugs during skin surgery in ways that are in concordance with the national guideline has increased since 2012. However, continuing antithrombotic drugs during large excisions and sentinel lymph node biopsies, abstaining from bridging patients on phenprocoumon with heparin, and continuing antithrombotic combination therapies perioperatively need to be further encouraged, especially among office-based dermatologists.

Peri‐operative management of direct Xa and IIa inhibitors for dermatologic surgery: A survey of current practice among French dermatologists

“…The lack of robust data on the use of DOACs in this setting and the lack of specific French guidelines may explain part of this heterogeneity. Similar studies conducted in Germany 9 and among American Mohs surgeons 10 also found that practices pattern variate between surgeons, but also deviate from guidelines.…”

Direct oral anticoagulants in skin surgery: a systematic review of their complications and recommendations for perioperative management

“…Logically, as the size of the excision or complexity of the surgical procedure increased, the proportion of dermatologists recommending uninterrupted DOAC therapy decreased. Similarly, a more recent survey of over 250 German dermatological surgeons found the vast majority (>70%) continued rivaroxaban in the setting of small (e.g., nevus) and large (e.g., melanoma) skin excisions with practices remaining consistent between hospital and office‐based clinicians 35 . For larger excisions and sentinel lymph node biopsies (procedures only performed by the hospital‐based dermatologists surveyed), the proportions of those continuing DOAC therapy was reduced to between 15 and 30%.…”

Ohne Werbung kein Effekt?

“…Hier helfen gezielte Umfragen, wie die Untersuchung von Scherer et al. in dieser Ausgabe des JDDG [3]. Darin geht es um die Umsetzung von Empfehlungen einer inzwischen als Update vorliegenden Leitlinie zum Umgang mit Blutverdünnern bei Eingriffen an der Haut [4].…”