Controversies in perioperative management of blood thinners in dermatologic surgery: continue or discontinue?
BACKGROUND
The use of blood thinners has increased dramatically in recent years among the general, and especially among the elderly, population. When these patients need to undergo cutaneous surgery, the surgeon encounters the obvious problem of whether to stop these medications before surgery.


OBJECTIVE
The objective was to evaluate the risks and benefits associated with the continuation of blood thinners perioperatively in cutaneous and Mohs micrographic surgery.


METHODS
The study comprises two parts: a search of the literature in English that examined articles that related to the perioperative use of blood thinners in dermatologic surgery and a presentation of data of continuous warfarin therapy in patients who underwent Mohs surgery in our practice.


RESULTS
A total of 15 articles were published in the literature until October 2003. One article showed an increase in complications in patients treated with warfarin, but not with aspirin. All other articles showed no increase in complications during the perioperative period. Data from our practice showed that of a total of 2790 patients, 68 were operated on while taking warfarin (2.4%). Intraoperative bleeding was easily controlled and postoperative bleeding was not recorded in any of the patients.


CONCLUSIONS
Continuous treatment with blood thinners perioperatively in patients undergoing Mohs and cutaneous surgery is not associated with an increase in surgical complications. Discontinuation of these medications may increase the risk of cerebral and cardiovascular complications.
Alcalay
Joseph
J
Mohs Surgery Unit, Assuta Medical Center, Tel Aviv, Israel. alcalays@zahav.net.il
Alkalay
Ronen
R
D000925:Anticoagulants / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000139:chemically induced*; D015580:Mohs Surgery; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000601:surgery*; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin