Thrombotic complications with interruption of direct oral anticoagulants in dermatologic surgery

Siscos, Spyros M.; Neill, Brett C.; Singh, Anjali Hocker; Hocker, Thomas L.

doi:10.1016/j.jaad.2020.10.008

Cited by 9 publications

(14 citation statements)

References 36 publications

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“…Of the 13 articles, four were prospective observational cohort studies, one was a retrospective case-control study, and the remaining eight were retrospective observational cohort studies (Appendix S1). [15][16][17][18][19][20][21][22][23][24][25][26][27] Over 12 years, there were 10,750 patients who underwent cutaneous surgery, with 1,312 of them performed on patients prescribed a DOAC. The mean participant age ranged from 68 to 78.8 years of age, with a male predominance (49.9-81.8%).…”

Section: Resultsmentioning

confidence: 99%

“…The included articles studied four areas: (1) complication rate in those who continued DOAC therapy, 15,16 (2) complication rate in those who ceased DOAC therapy prior to undergoing skin surgery, 17,18 (3) complication rate between patients who had their DOAC therapy ceased vs continued, 19 and (4) comparing complication rate in patients anticoagulated with a DOAC agent vs a control group not on a DOAC agent (Table 1). [20][21][22][23][24][25][26][27] Outcomes DOAC continuation Antia et al 15 evaluated 76 MMS on patients who were prescribed a DOAC, resulting in one mild bleeding complication in a person taking rivaroxaban (1.32%).…”

Section: Resultsmentioning

confidence: 99%

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

Ireland,

Borruso,

Spencer

et al. 2023

Int J Dermatology

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IntroductionMany patients undergoing cutaneous surgery are prescribed at least one anticoagulant or antiplatelet agent. With the recent emergence of direct oral anticoagulants (DOACs), there is a deficit of knowledge regarding optimal perioperative management. This review aims to evaluate the evidence and risk surrounding management of DOACs in patients undergoing skin surgeries.MethodsSystematic review of EMBASE, Scopus, and PubMed, with inclusion of studies that detailed perioperative management of DOACs in those undergoing skin surgery. Primary outcome measures were perioperative hemorrhagic and thromboembolic complications.ResultsSeven thousand seven hundred and forty‐one abstracts were identified, with 13 articles meeting inclusion criteria. Two studies investigated complication risk associated with DOAC continuation in skin surgery and found an average rate of hemorrhagic complications of 1.74%. Two studies evaluated complications associated with DOAC cessation prior to skin surgery, with a pooled thromboembolic complication rate of 0.15%. Articles comparing continuation and cessation discovered no decreased risk of bleeding with DOAC cessation prior to surgery (P = 0.93). Seven of the 13 articles compared complications in a control vs a DOAC group undergoing cutaneous procedures. Evidence was conflicting but may have suggested a small increase in bleeding risk in those on DOAC therapy.ConclusionOptimal management of anticoagulants perioperatively is difficult because of conflicting information, complicated by advent of novel agents. Risk of hemorrhagic complications with both continuation and interruption of DOAC therapy was low. Perioperative DOAC management can be guided by procedural bleeding and patient clotting risk and can often be continued in minor dermatologic procedures.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Ireland,

Borruso,

Spencer

et al. 2023

Int J Dermatology

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“…Conversely, a retrospective study found that perioperative NOAC interruption during dermatologic surgery was associated with a low incidence of thrombotic events in patients with nonvalvular atrial fibrillation or a history of deep vein thrombosis or pulmonary embolism. 12 In light of these data, it may be reasonable to consider NOAC interruption in specific patient populations on combination therapy if large repairs or significant undermining are expected. Any decisions to modify a patient's anticoagulation regimen should be made in collaboration with the patient and the physician managing the patient's antithrombotic medications.…”

Section: Discussionmentioning

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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“…4 A recent study demonstrated that the peri-operative withholding of DOACs in patients with nonvalvular atrial fibrillation or a history of venous thromboembolism during dermatologic surgery appears to be safe and efficacious. 7 Nonetheless, it should be noted that the risk of bleeding complications in patients taking DOACs may be limited by meticulous surgical techniques, elaborate haemostasis, pressure dressings, and close postoperative follow-up. 8 This study shows that among French dermatologists, there has yet to be a consensus on the management of DOACs before and after dermatologic surgery.…”

Section: Peri-operative Management Of Direct Xa and Iia Inhibitors Fo...mentioning

confidence: 99%

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

Samaran

Lacombe

Cogrel

et al. 2023

Acad Dermatol Venereol

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Thrombotic complications with interruption of direct oral anticoagulants in dermatologic surgery

Cited by 9 publications

References 36 publications

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

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

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

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

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