Perioperative management of anticoagulant therapy during cutaneous surgery: 2005 survey of Mohs surgeons.
BACKGROUND
The perioperative management of anticoagulation and antiplatelet therapy is a controversial topic in the field of dermatologic surgery. Dermasurgeons must weigh the risk of bleeding against the risk of thrombotic complications when deciding how to manage perioperative anticoagulation.


OBJECTIVE
Our aim is to present a summary of current practice in anticoagulation management perioperatively during cutaneous surgery. We compare our results to those found in a similar survey in 2002.


METHODS
A questionnaire surveying current practice in perioperative management of anticoagulant therapy was mailed to 720 dermasurgeons.


RESULTS
Thirty-eight percent of dermasurgeons responded to the questionnaire. Of the responding physicians, 87% discontinue prophylactic aspirin therapy, 37% discontinue medically necessary aspirin, 44% discontinue warfarin, 77% discontinue nonsteroidal anti-inflammatory drugs (NSAIDs), and 77% discontinue vitamin E therapy perioperatively at least some of the time. Although clopidogrel was not surveyed, 78 physicians included comments about the management of this agent.


CONCLUSIONS
Dermasurgeons were more likely to continue medically necessary aspirin and warfarin in 2005 compared to 2002, with the most dramatic shift evident in the management of warfarin. They were more likely to discontinue prophylactic aspirin, NSAIDs, and vitamin E. Surgeons were concerned about bleeding with the antiplatelet agent clopidogrel. More evidence-based medicine is necessary to set guidelines for the management of anticoagulation and antiplatelet therapy perioperatively.
Kirkorian
A Yasmine
AY
Department of Dermatology, Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
Moore
Betty L
BL
Siskind
Jodi
J
Marmur
Ellen S
ES
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000077144:Clopidogrel; D003880:Dermatology; D017723:Drug Utilization Review; D006801:Humans; D015580:Mohs Surgery; D019990:Perioperative Care; D010818:Practice Patterns, Physicians'; D012871:Skin Diseases / Q000601:surgery*; D011795:Surveys and Questionnaires; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D014481:United States; D014810:Vitamin E / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D014810:Vitamin E; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin