Patients with drug-eluting stents and management of their anticoagulant therapy in cutaneous surgery.
Whether a patient has a drug-eluting stent (DES) implanted may not seem to be an immediate concern for a dermatologist. However, the clinician needs to consider a patient's risk of bleeding if a patient is to undergo a cutaneous surgical procedure. Patients with skin cancer are generally older with a higher risk of comorbidities such as cardiovascular disease with history of cardiac stent implantation. After DES placement, patients are typically on long-term dual antiplatelet therapy, which increases the risk of bleeding. However, stopping antiplatelet therapy prematurely can lead to serious thrombotic complications. Thus, when performing a dermatologic procedure in a patient with a DES, the physician must weigh the risks of bleeding complications with continuing antiplatelet therapy against the risk of thrombotic complications associated with stopping antiplatelet therapy. The aim of this review is to identify the issues for the dermatologist and the dermatologic surgeon surrounding the perioperative treatment of patients with a DES and to discuss the treatment of patients with an implanted DES.
Saint Louis University School of Medicine, Saint Louis, Missouri, USA.
Melinda B
MB
Chu
Ryan B
RB
Turner
David A
DA
Kriegel
D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D062109:Dermatologic Surgical Procedures; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013927:Thrombosis / Q000139:chemically induced; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin