title: Bleeding complications in cutaneous surgery for patients on warfarin who have skin cancer of the head and neck.
abstract: Many patients who have operations on the head and neck for skin cancer also take warfarin to prevent thromboembolic events, and there is still debate about whether treatment should be continued, adjusted, or temporarily stopped. The main concern is to balance the risk of haemorrhagic and thromboembolic events. In this prospective controlled study we compared bleeding complications in operations for skin cancer of the head and neck between 86 patients who took warfarin (100 tumours) and 87 (100 tumours) who did not. Surgeons of different grades did the operations under the guidance of the same consultant. All those on warfarin had above normal international normalised ratios (INRs) (mean (SD) 2.5 (0.51), mode 2.6, range 1.1-4.0). In the warfarin group 8% of excisions had a bleeding complication compared with 9% in the control group. One patient in each group suffered a severe bleed that required a return to theatre. The difference in tendency to bleed between the groups was not significant (p=0.30), and the site and type of reconstruction did not influence the risk of bleeding significantly. This study shows that patients on warfarin who are within the normal therapeutic range, can be operated on safely for skin cancer by all levels of trained staff.
authors.affiliation: Department of Oral and Maxillofacial Surgery, York Teaching Hospitals Foundation Trust, Wigginton Road, York YO31 8HE, United Kingdom. Electronic address: m.w.harbottle@btinternet.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Harbottle
authors.affiliation: Department of Oral and Maxillofacial Surgery, York Teaching Hospitals Foundation Trust, Wigginton Road, York YO31 8HE, United Kingdom. Electronic address: Martin.telfer@york.nhs.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Telfer
authors.affiliation: Department of Oral and Maxillofacial Surgery, York Teaching Hospitals Foundation Trust, Wigginton Road, York YO31 8HE, United Kingdom. Electronic address: prem.hunjan@gmail.com.
authors.forename: Premneaq Singh
authors.initials: PS
authors.lastname: Hunjan
authors.affiliation: Gloucestershire Hospitals NHS Foundation Trust, Gloucester Royal Infirmary, Great Western Road, Gloucester GL1 3NN, United Kingdom. Electronic address: Greg.Knepil@glos.nhs.uk.
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Knepil
authors.affiliation: Department of Oral and Maxillofacial Surgery, York Teaching Hospitals Foundation Trust, Wigginton Road, York YO31 8HE, United Kingdom. Electronic address: rabipratap2@googlemail.com.
authors.forename: Rabindra Pratap
authors.initials: RP
authors.lastname: Singh
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D016022:Case-Control Studies; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005153:Facial Neoplasms / Q000601:surgery; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D019934:International Normalized Ratio; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D012307:Risk Factors; D012449:Safety; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000637:transplantation; D013923:Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Bleeding complications; Facial skin cancer; Warfarin