title: S3 guidelines for the management of anticoagulation in cutaneous surgery.
abstract: BACKGROUND
  An increasing number of patients are being treated with anticoagulants and platelet inhibitors. Whenever surgical procedures of the skin are required, questions arise regarding the perioperative management of anticoagulation.
  
  
  METHODS
  Development of S3 guidelines following the requirements of the Association of Scientific Medical Societies, systematic literature search and analysis, use of GRADE methodology, structured consensus conference using a nominal group process.
  
  
  RESULTS
  During cutaneous surgery, treatment with acetylsalicylic acid (ASA) should be continued if medically necessary. In procedures with a higher risk of bleeding and a positive bleeding history, INR should be determined preoperatively. Surgical procedures of the skin with a higher risk of bleeding should not be performed if the INR is above therapeutic range. Bridging from vitamin K antagonists (VKA) to heparin should not be performed just because of the surgery of the skin. As to direct-acting oral anticoagulants, the last dose should be taken 24 h preoperatively.
  
  
  CONCLUSIONS
  The recommendations issued by the German guidelines group are mostly in line with recommendations provided by other guidelines. The American ìChest-Guidelineì recommends continuing VKAs and acetylsalicylic acid during minor dermatologic procedures. In their guidelines, the German College of General Practitioners and Family Physicians considers an INR of 2 to be adequate in surgical procedures on the skin.
authors.affiliation: Division of Evidence Based Medicine, Charité - Universitätsmedizin Berlin.
authors.forename: Birte
authors.initials: B
authors.lastname: Sporbeck
authors.forename: Falk
authors.initials: F
authors.lastname: Georges Bechara
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Häfner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenen
authors.forename: Andreas
authors.initials: A
authors.lastname: Kolk
authors.forename: Jürgen
authors.initials: J
authors.lastname: Koscielny
authors.forename: Markus
authors.initials: M
authors.lastname: Meissner
authors.forename: Anna
authors.initials: A
authors.lastname: Pokrywka
authors.forename: Steffen
authors.initials: S
authors.lastname: Schirmer
authors.forename: Klaus
authors.initials: K
authors.lastname: Strömer
authors.forename: Christoph
authors.initials: C
authors.lastname: Löser
authors.forename: Alexander
authors.initials: A
authors.lastname: Nast
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D062109:Dermatologic Surgical Procedures / Q000009:adverse effects / Q000592:standards*; D003880:Dermatology / Q000592:standards*; D005858:Germany; D006801:Humans; D017410:Practice Guidelines as Topic; D011292:Premedication / Q000592:standards*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants