Preoperative monitoring of warfarin in cutaneous surgery

Abstract

Our experience supports the continued and safe use of warfarin for a wide variety of cutaneous surgical procedures with a preoperative INR of < 3.5. We recommend a routine INR before the procedure, preferably within 24 h.

A prospective assessment of bleeding and international normalized ratio in warfarin-anticoagulated patients having cutaneous surgery

“…2,14 A number of recent retrospective and prospective studies have shown that cutaneous surgery patients taking warfarin have an insignificant risk for severe bleeding in the postoperative period. [4][5][6]9 Alcalay 6 found no increase in postoperative bleeding in his study of 16 warfarin-treated patients compared to controls. Ah-Weng and colleagues 4 performed a retrospective review of 68 warfarin-treated patients that had perioperative INR levels checked before performing a variety of dermatologic procedures primarily consisting of punch and shave biopsies.…”

“…[3][4][5][6][7][8][9][10] Many of these studies have been retrospective in nature, 4,5 and the few prospective studies currently in print enrolled fewer than 20 patients taking warfarin. [6][7][8][9] Many studies have also limited their focus on the incidence of severe postoperative bleeding complications, such as hematoma or uncontrollable intraoperative or postoperative bleeding.…”

Bleeding complications in skin cancer surgery are associated with warfarin but not aspirin therapy

“…The INR should be at the lower end of therapeutic range, especially when several additional risk factors are present. A fixed INR recommendation cannot be made as the therapeutic range recommended for patients depends on the indication for anticoagulation 9,24 .…”

“…In recent years surgeons have been encouraged to continue warfarin and/or aspirin therapy before excision of skin tumours 4 -6,8 -14 , accepting an international normalized ratio (INR) of up to 3·5 9 . Stopping antithrombotic drugs risks life-threatening thromboembolic sequelae, even when medication is stopped only for a short period 1,15 -17 .…”

Sellar and parasellar tumor removal without discontinuing antithrombotic therapy

“…4,5,21,28 Evidence-based recommendations have been proposed to deal with this complicated countermeasure in some less invasive procedures with lower risk of bleeding, such as dental procedures or cataract operations. [1][2][3][6][7][8][9][10][11][12][13][14][15][16][17][18][19][21][22][23][24][25]29,30,[32][33][34][35][36][37][38] However, procedures without discontinuation of antithrombotic treatment have received little attention, 39 and the perioperative period in neurosurgical procedures has also been less well studied. 20,26,27,31,[40][41][42] The present clinical study retrospectively analyzed a series of transsphenoidal surgeries performed without discontinuation of antithrombotic therapy for comparison with the same number of transsphenoidal surgeries performed in the absence of antithrombotic therapy.…”