title: Prospective multicentre cohort study on 9154 surgical procedures to assess the risk of postoperative bleeding - a DESSI study.
abstract: BACKGROUND
  To date, there is still a debate how to deal with patients receiving antithrombotic agents prior to surgical procedures on the skin.
  
  
  OBJECTIVE
  To prospectively assess complications after dermatosurgical interventions, especially bleeding, depending on anticoagulation therapy.
  
  
  METHODS
  Patients underwent surgery consecutively as scheduled, without randomization, whether or not they were currently taking anticoagulants. Nine institutions of the DESSI (DErmatoSurgical Study Initiative) working group documented patient data prospectively on a standardized study sheet prior to and after 9154 dermatosurgical interventions.
  
  
  RESULTS
  Bleeding complications were observed in 7.14% of cases (654/9154 surgeries). A severe bleed requiring intervention by a physician occurred in 83 surgeries (0.91%). In multivariate analysis, INR, length of the defect, perioperative antibiotic treatment, current treatment with anticoagulation therapy, age and surgery on hidradenitis suppurativa/acne inversa (HS/AI) were significant parameters independently influencing the risk of bleeding. Discontinuation of phenprocoumon therapy and subsequent switching to low molecular weight heparin was associated with the highest risk of bleeding (9.26%).
  
  
  CONCLUSIONS
  Bleeding complications in skin surgery are generally rare. Even if slightly increased complication rates are found in patients taking anticoagulants during skin surgery, platelet inhibitors should not be stopped prior to surgery. If a surgical procedure in patients on a combination therapy of 2 or more antiplatelet cannot be postponed, it should be conducted with the patient remaining on combination therapy. Discontinuation of DOACs is recommended 24 h prior to surgery. Bridging of phenprocoumon should be terminated. In patients with a bleeding history, the INR value should be within the therapeutic range.
authors.affiliation: Department of Dermatology and Allergy, University Hospital Mannheim, Mannheim, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Koenen
authors.affiliation: Department of Dermatology and Allergy, University Hospital Munich (LMU), Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kunte
authors.affiliation: Department of Dermatology and Allergy, University Hospital Munich (LMU), Munich, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Hartmann
authors.affiliation: Department of Dermatology, University Hospital Tübingen, Tübingen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Breuninger
authors.affiliation: Department of Dermatology, University Hospital Tübingen, Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Moehrle
authors.affiliation: Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany.
authors.forename: F G
authors.initials: FG
authors.lastname: Bechara
authors.affiliation: Department of Dermatology, Center for Skin Tumors, Münster-Hornheide, Münster, Germany.
authors.forename: H J
authors.initials: HJ
authors.lastname: Schulze
authors.affiliation: Department of Dermatology, Center for Skin Tumors, Münster-Hornheide, Münster, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Lösler
authors.affiliation: Dermatology Hospital and Skin Tumor Center, Ludwigshafen Hospital, Ludwigshafen, Germany.
authors.forename: C R
authors.initials: CR
authors.lastname: Löser
authors.affiliation: Department of Dermatology, Venereology and Allergology, University of Leipzig Medical Centre, Leipzig, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Wetzig
authors.affiliation: Department of Dermatology, University Hospital Münster, Münster, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Pappai
authors.affiliation: Department of Dermatology, Hospital of Darmstadt, Darmstadt, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Rapprich
authors.affiliation: Department of Biostatistics, University Hospital Mannheim, Mannheim, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Weiß
authors.affiliation: Department of Dermatology and Allergy, University Hospital Mannheim, Mannheim, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Faulhaber
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects*; D062109:Dermatologic Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000009:adverse effects; D017497:Hidradenitis Suppurativa / Q000601:surgery; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010644:Phenprocoumon / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012871:Skin Diseases / Q000601:surgery*; D000072836:Surgical Wound / Q000150:complications
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D006493:Heparin; D010644:Phenprocoumon