A Review of Antithrombotic Agents in Dermatologic Surgery and Context for a Practical Approach, With Cardiology and Pharmacologic Input
May 2023 | Volume 22 | Issue 5 | 496 | Copyright © May 2023
Published online April 25, 2023
Elizabeth Rao BSca, Wyatt Andrasik MDb, Basia M. Michalski MDb, Khaldoun G. Tarakji MD MPHc, Michael A. Militello PharmDd, Jennifer L. Lucas MDb
aCase Western Reserve University School of Medicine, Cleveland, OH
bCleveland Clinic, Dermatology and Plastic Surgery Institute, Cleveland, OH
cCleveland Clinic, Cardiovascular Medicine Department, Cleveland, OH
dCleveland Clinic, Department of Pharmacy, Cleveland, OH
Abstract
Dermatologic surgeons are encountering more patients on antithrombotic agents. There are no established consensus guidelines for managing antithrombotic agents in the perioperative period. We provide an updated overview of antithrombotic agents in dermatologic surgery and management of such agents in the perioperative period with additional unique perspectives from cardiology and pharmacy. A literature search of PubMed and Google Scholar was performed to review the English-language medical literature. The landscape of antithrombotic therapy is changing with a notable rise in the use of direct oral anticoagulants (DOACs.) While no consensus guidelines exist, most studies recommend continuing antithrombotic therapy in the perioperative period with appropriate lab monitoring, when applicable. However, recent data suggest it is safe to hold DOACs in the perioperative period. As antithrombotic therapy evolves, the dermatologic surgeon needs to remain current with the most recent available data. Where data are limited, a multidisciplinary approach to managing these agents in the perioperative period is essential.
J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7456
Rao E, Andrasik W, Michalski BM, et al. A review of antithrombic agents in dermatologic surgery and context for a practical approach, with cardiology and pharmacologic input.
J Drugs Dermatol. 2023;22(5):496-501. doi:10.36849/JDD.7456
INTRODUCTION
Dermatologic surgeons are performing an increasing number of surgeries to diagnose and treat cutaneous malignancies.1 Bleeding complications occur in approximately 0.1% to 4% of patients, with patients taking antithrombotic therapies at highest risk.1-4 Dermatologic surgeons are encountering more patients on antithrombotic therapies, including direct oral anticoagulants (DOAC).5 However, no consensus guidelines exist in dermatology for perioperative management of antithrombotic agents.
Our study offers the most up-to-date overview of antithrombotic agents in dermatologic surgery and recommendations for perioperative management, reports of new techniques to mitigate bleeding, and additional perspectives from cardiology and pharmacy.
MATERIALS AND METHODS
A review of English-language medical literature from 2000 to 2022 was performed using PubMed and Google Scholar. Guidelines from the American Heart Association, American College of Cardiology, American College of Chest Physicians, American Stroke Association, and New European Rhythm Association were additionally reviewed.
RESULTS
Anti-coagulants, anti-platelets, and supplements that affect hemostasis are summarized in Table 1. Recommendations are summarized in Table 2.
