Perioperative management of anticoagulants and platelet inhibitors for cutaneous surgery: a survey of current practice

Abstract

Background: Perioperative management of therapy with anticoagulants or platelet inhibitors for patients having cutaneous surgery presents dilemmas for dermatologic surgeons.

Objective: To outline the current spectrum of practice for perioperative management.

Methods: Questionnaires were mailed to 504 dermatologic surgeons. Data included use of warfarin, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs) perioperatively and involvement of other physicians in making management decisions.

Results: Of the responding physicians, 83% routinely ask primary physicians or cardiologists for recommendations about perioperative management, 80% discontinue warfarin therapy perioperatively at least some of the time, 26% always discontinue aspirin therapy, 38% manage aspirin and NSAIDs in the same manner, and 53% withhold therapy with NSAIDs for less time than with aspirin.

Conclusion: Dermatologic surgeons use various perioperative management strategies. Despite no published evidence of increased hemorrhagic risk with anticoagulant or platelet inhibitor therapy during cutaneous surgery, many physicians discontinue therapy perioperatively.