title: Evaluation of the risk of post-operative bleeding complications in skin cancer surgery without interruption of anticoagulant/antithrombotic medication: A prospective cohort study.
abstract: BACKGROUND
  Previous reports showed lack of consensus concerning interruption of anticoagulant/antithrombotic (AC/AT) treatment before skin cancer surgery.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the risk of postoperative bleeding in patients on AC/AT treatment undergoing skin cancer surgery without interruption of this treatment.
  
  
  METHODS
  This prospective cohort study included 271 consecutive patients divided into two groups - patients without and patients with AC/AT therapy. Inclusion criteria were skin cancer (basal-cell carcinoma, squamous-cell carcinoma, or malignant melanoma). Exclusion criteria were patients undergoing regional lymph node dissection or sentinel lymph node biopsy. Postoperative bleeding complications taken into consideration were those evaluated as moderate or severe and requiring some form of surgical or non-surgical hemostasis on an outpatient or inpatient basis.
  
  
  RESULTS
  There were 47 patients in the AC/AT group and 224 in the control group (mean age = 76.6 and 68 years, respectively), with almost equal distribution of tumours in both groups. There were 34.1% of patients on AT, 55% on AC treatment, and 10.6% on mixed treatment (AC+AT or AT+AT). Postoperative bleeding complications did not show a statistically significant difference between the two groups (p = 0.063).
  
  
  CONCLUSIONS
  Skin cancer surgery can be safely performed without discontinuation of AC/AT treatment, since the risk of postoperative bleeding is statistically insignificant.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Croix Rousse Hospital , Lyon , France.
authors.forename: Hristo
authors.initials: H
authors.lastname: Shipkov
authors.forename: Charles
authors.initials: C
authors.lastname: Irthum
authors.forename: Pierre
authors.initials: P
authors.lastname: Seguin
authors.forename: Ali
authors.initials: A
authors.lastname: Mojallal
authors.forename: Fabienne
authors.initials: F
authors.lastname: Braye
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000601:surgery; D061214:Patient Safety; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012306:Risk; D012878:Skin Neoplasms / Q000601:surgery*; D013524:Surgical Flaps
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: anticoagulant; antiplatelet; postoperative bleeding; skin cancer