title: Surgical resection of cutaneous head and neck lesions: does aspirin use increase hemorrhagic risk?
abstract: OBJECTIVE
  To determine whether the antiplatelet agent aspirin increases hemorrhagic risk in patients undergoing surgical resection of cutaneous head and neck lesions.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Regional referral center. Patients All cases of cutaneous head and neck lesions surgically resected during a 10-year period were included.
  
  
  METHODS
  Outcome measures were incidence of significant postoperative hemorrhage, defined as postoperative hematoma or hemorrhage necessitating surgical reexploration; and total postoperative hemorrhage, defined as any hemorrhage lasting longer than 4 hours despite external pressure, requiring medical review, and resulting in prolongation of the patient's hospital stay or readmission to the hospital.
  
  
  RESULTS
  Seven hundred eleven patients (974 cases) were eligible for inclusion, of whom 320 were receiving aspirin therapy at the time of surgery. The incidence of significant postoperative hemorrhage in the aspirin and nonaspirin groups was 5 (1.6%) and 0, respectively (P = .004), and aspirin use was the only risk factor for significant postoperative hemorrhage. The incidence of total postoperative hemorrhage in the aspirin and nonaspirin groups was 7 (2.2%) and 1 (0.1%), respectively (P = .002). At multivariate analysis, aspirin use and local flap reconstruction were independent risk factors for total postoperative hemorrhage. Cases receiving aspirin therapy who also underwent local flap reconstruction were at exponential (124-fold) increased risk of total postoperative hemorrhage compared with cases with neither risk factor.
  
  
  CONCLUSIONS
  Aspirin intake at the time of surgery to resect cutaneous head and neck lesions confers a small but statistically increased risk of postoperative hemorrhage. This risk is particularly pronounced in patients undergoing local flap reconstruction.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Raigmore Hospital, Inverness, Scotland. dhiwamahi@yahoo.com
authors.forename: Muthuswamy
authors.initials: M
authors.lastname: Dhiwakar
authors.forename: Najib A
authors.initials: NA
authors.lastname: Khan
authors.forename: Leo G
authors.initials: LG
authors.lastname: McClymont
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000601:surgery*; D013524:Surgical Flaps
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin