A guide to anticoagulation and endocarditis prophylaxis during cutaneous surgery.
Management of perioperative antiplatelet/anticoagulation drugs and appropriate antibiotic prophylaxis for endocarditis are two controversial issues in the safe practice of cutaneous surgery. This article highlights the current best practice based on a literature review on these topics. Antiplatelet agents should be continued perioperatively whenever clinically possible, and discontinued only after consultation with the patient's cardiologist. The exception to this is primary cardiovascular disease, when antiplatelet drugs should be stopped for 1 week before surgery. Warfarin can be continued perioperatively when the international normalised ratio is controlled at < 3. The use of antibiotics in patients at risk of endocarditis has been recently reviewed by the National Institute of Health and Clinical Excellence (NICE), the American Heart Association, and the European Society of Cardiology. The advice has changed significantly over the past few years, and the routine use of antibiotics perioperatively should occur only when there is evidence of infection perioperatively at the site of surgery.
Child
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N
Cardiology Unit, Dorset County Hospital, Dorchester, Dorset, UK.
Anjum
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N
Keohane
S G
SG
Cooper
H L
HL
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D000077144:Clopidogrel; D004176:Dipyridamole / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000517:prevention & control*; D006801:Humans; D019934:International Normalized Ratio; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012871:Skin Diseases / Q000601:surgery*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D002121:Calcium Channel Blockers; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin