Skin Surgery: Preventing Excessive Bleeding

Risk of complications due to anticoagulation during dermatosurgical procedures: a systematic review and meta-analysis. Nast A. et al. J Eur Acad Dermatol Venereol. 2014 Dec;28(12):1603-9. doi: 10.1111/jdv.12611. Epub 2014 Jul 30.

-When undergoing surgery, there is often big concerns regarding excessive bleeding. It can be a problem in “classical” surgery, but in Dermatosurgery, the following study suggests that it is of a lower risk in that regard.

-Patients sometimes take medication which interferes with clot formation, and therefore bleeding is prolonged and the volume lost bigger. Such medications include aspirin (anti-platelet aggregator) and heparin/warfarin (anticoagulants)

-In this retrospective study, the authors did a review (Medline and Cochrane) of all publications (1287) and studies (10) assessing the risk of complications due to anticoagulation during cutaneous surgery

–Results show that the bleeding in the control group was low=1%. In comparison to that:

• for aspirin: compared with controls the relative risk (RR) was:
  • 1.1 for mild-to-moderate post operative bleeding (NO SIGNIFICANT DIFFERENCE)
  • 0.9 for severe bleeding (NO SIGNIFICANT DIFFERENCE)
• higher for warfarin (RR):
  • 3.2 for mild to moderate post-operative bleeding
  • 14.8 for severe bleeding

-To conclude the risk of risky hemorrhage (bleeding) is low:

• especially for aspirin where it appears to be negligible. The patients could therefore continue taking aspirin normally when undergoing a skin surgical procedure.
• However, for warfarin, the risk:
  • is around 3 times that of controls for mild-to-moderate post-operative bleeding
  • rises to 15 times for severe bleeding (although it was rare in absolute numbers). According to the authors’ estimate), the risk of severe hemorrhage would be 2=fold).

Final word: the decision to stop or continue taking the medication is always on a case-by-case basis and the risks should be evaluated taking into account the patient as a whole (history, general health…)

Comment:
-studies were small and the methodology quality low
-a prospective study would be welcome.

Article selection: Prof Dr Jean-Hilaire Saurat – dermatologist. Geneva, Switzerland