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Pradaxa, Xarelto continuation acceptable during cutaneous surgery

Patients treated with anticoagulants Pradaxa and Xarelto did not experience severe hemorrhagic complications during cutaneous surgery, and continuation of the medications during surgery is a reasonable approach, according to study results.

Researchers at Mayo Clinic, Rochester, Minn., conducted a retrospective chart analysis of patients who underwent Mohs micrographic surgery or basic excision while being treated with Pradaxa (dabigatran, Boehringer Ingelheim) or Xarelto (rivaroxaban, Janssen) between Jan. 1, 2010, and Sept. 1, 2013.

Twenty-seven patients (20 men; mean age, 78.8 years) on dabigatran had 41 cutaneous surgeries. Dabigatran had been prescribed for atrial fibrillation and/or stroke prophylaxis. One patient experienced mild bleeding complications, which were alleviated with a pressure dressing.

Four patients (three men; mean age, 75 years) treated with rivaroxaban underwent five cutaneous surgeries. Rivaroxaban had been prescribed for atrial fibrillation and stroke prophylaxis or treatment of deep vein thrombosis and pulmonary embolism. No complications were observed in the four patients.

“With the recent advent of new blood-thinning medications and the likelihood of others to come, the perioperative management of patients during cutaneous surgery is becoming more complex,” the researchers wrote.

“Given the potential for severe thrombotic complications associated with the discontinuation of medically necessary anticoagulants and the apparent low risk of continuing these medications, the authors believe that the most reasonable approach is for patients to continue using them during cutaneous surgery. Strategies for individual patients should be adjusted on the basis of their specific circumstances.” – By Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.