Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications
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Authors
Bordeaux, Jeremy S.Martires, Kathryn J.
Goldberg, Dori
Pattee, Sean F.
Fu, Pingfu
Maloney, Mary E.
UMass Chan Affiliations
Department of Medicine, Division of DermatologyDocument Type
Journal ArticlePublication Date
2011-09-01Keywords
AgedAmbulatory Surgical Procedures
Antibiotic Prophylaxis
Anticoagulants
*Dermatologic Surgical Procedures
Female
Humans
Male
Mohs Surgery
Necrosis
Platelet Aggregation Inhibitors
Postoperative Complications
Postoperative Hemorrhage
Surgical Flaps
Surgical Wound Infection
Ticlopidine
Warfarin
Dermatology
Skin and Connective Tissue Diseases
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Show full item recordAbstract
BACKGROUND: Few prospective studies have evaluated the safety of dermatologic surgery. OBJECTIVE: We sought to determine rates of bleeding, infection, flap and graft necrosis, and dehiscence in outpatient dermatologic surgery, and to examine their relationship to type of repair, anatomic location of repair, antibiotic use, antiplatelet use, or anticoagulant use. METHODS: Patients presenting to University of Massachusetts Medical School Dermatology Clinic for surgery during a 15-month period were prospectively entered. Medications, procedures, and complications were recorded. RESULTS: Of the 1911 patients, 38% were on one anticoagulant or antiplatelet medication, and 8.0% were on two or more. Risk of hemorrhage was 0.89%. Complex repair (odds ratio [OR] = 5.80), graft repair (OR = 7.58), flap repair (OR = 11.93), and partial repair (OR = 43.13) were more likely to result in bleeding than intermediate repair. Patients on both clopidogrel and warfarin were 40 times more likely to have bleeding complications than all others (P = .03). Risk of infection was 1.3%, but was greater than 3% on the genitalia, scalp, back, and leg. Partial flap necrosis occurred in 1.7% of flaps, and partial graft necrosis occurred in 8.6% of grafts. Partial graft necrosis occurred in 20% of grafts on the scalp and 10% of grafts on the nose. All complications resolved without sequelae. LIMITATIONS: The study was limited to one academic dermatology practice. CONCLUSION: The rate of complications in dermatologic surgery is low, even when multiple oral anticoagulant and antiplatelet medications are continued, and prophylactic antibiotics are not used. Closure type and use of warfarin or clopidogrel increase bleeding risk. However, these medications should be continued to avoid adverse thrombotic events. All rights reserved.Source
Bordeaux JS, Martires KJ, Goldberg D, Pattee SF, Fu P, Maloney ME. Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications. J Am Acad Dermatol. 2011 Sep;65(3):576-83. doi: 10.1016/j.jaad.2011.02.012.
DOI
10.1016/j.jaad.2011.02.012Permanent Link to this Item
http://hdl.handle.net/20.500.14038/28381PubMed ID
21782278Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.jaad.2011.02.012