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Anticoagulant, antiplatelet medications carry rare dermatologic surgery hemorrhage risks

Dermatologists and dermatologic surgeons should be aware of the bleeding risks of anticoagulant and antiplatelet drugs used for cardiovascular diseases, according to findings from a recent literature review.

The researchers conducted a PubMed search for the keywords “aspirin,” “warfarin,” “clopidogrel,” “dabigatran,” “rivaroxaban,” “apixaban, “prasugrel” and “ticagrelor” and selected review articles and publications that emphasized perioperative management of oral anticoagulant or antiplatelet medications. A second PubMed search was conducted for the words “hemorrhage,” “bleeding” and “thrombosis” in association with “dermatology,” “dermatologic surgery” and “cutaneous surgery.”

Shortfalls in dosing, monitoring and efficacy were found for aspirin, clopidogrel and warfarin. Dabigatran, rivaroxaban and apixaban displayed superior efficacy in several studies, along with equal or reduced bleeding risk when compared with warfarin, according to the researchers. However, prasugrel and ticagrelor were found to have a possible association with an increased bleeding risk.

Dietary supplements as complementary and alternative medicine, including garlic, ginseng, gingko, vitamin E, fish oil and ethanol, were also reviewed for anticoagulant properties.

 “The overall rate of perioperative or postoperative hemorrhage or hematoma formation in dermatologic surgery is extremely low (0.89% of cases),” the researchers wrote. “The consensus in recent literature favors perioperative continuation of medically necessary anticoagulant or antiplatelet medications in dermatologic surgery despite any perceived or real increased risk of hemorrhagic complications.”

Disclosure: The authors have no relevant financial disclosures.