Direct oral anticoagulants in skin surgery: a systematic review of their complications and recommendations for perioperative management

Patrick A. Ireland; Luca Borruso; Sascha K. R. Spencer; Richard Rosen; Robert Rosen

doi:10.1111/ijd.16916

journal article Open Access Nov 27, 2023

Direct oral anticoagulants in skin surgery: a systematic review of their complications and recommendations for perioperative management

Patrick A. Ireland

Luca Borruso Sascha K. R. Spencer Richard Rosen Robert Rosen

International Journal of Dermatology Vol. 63 No. 4 pp. 413-421 · Wiley

View at Publisher Save 10.1111/ijd.16916

Abstract

AbstractIntroductionMany patients undergoing cutaneous surgery are prescribed at least one anticoagulant or antiplatelet agent. With the recent emergence of direct oral anticoagulants (DOACs), there is a deficit of knowledge regarding optimal perioperative management. This review aims to evaluate the evidence and risk surrounding management of DOACs in patients undergoing skin surgeries.MethodsSystematic review of EMBASE, Scopus, and PubMed, with inclusion of studies that detailed perioperative management of DOACs in those undergoing skin surgery. Primary outcome measures were perioperative hemorrhagic and thromboembolic complications.ResultsSeven thousand seven hundred and forty‐one abstracts were identified, with 13 articles meeting inclusion criteria. Two studies investigated complication risk associated with DOAC continuation in skin surgery and found an average rate of hemorrhagic complications of 1.74%. Two studies evaluated complications associated with DOAC cessation prior to skin surgery, with a pooled thromboembolic complication rate of 0.15%. Articles comparing continuation and cessation discovered no decreased risk of bleeding with DOAC cessation prior to surgery (P = 0.93). Seven of the 13 articles compared complications in a control vs a DOAC group undergoing cutaneous procedures. Evidence was conflicting but may have suggested a small increase in bleeding risk in those on DOAC therapy.ConclusionOptimal management of anticoagulants perioperatively is difficult because of conflicting information, complicated by advent of novel agents. Risk of hemorrhagic complications with both continuation and interruption of DOAC therapy was low. Perioperative DOAC management can be guided by procedural bleeding and patient clotting risk and can often be continued in minor dermatologic procedures.

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4

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37

References

Details

Published: Nov 27, 2023
Vol/Issue: 63(4)
Pages: 413-421
License: View

Authors

P

Patrick A. Ireland

Prince of Wales Hospital Randwick NSW Australia; University of New South Wales Randwick NSW Australia

L

Luca Borruso

Royal Prince Alfred Hospital Camperdown NSW Australia

S

Sascha K. R. Spencer

Prince of Wales Hospital Randwick NSW Australia; University of New South Wales Randwick NSW Australia

R

Richard Rosen

Bankstown Hospital Bankstown NSW Australia

R

Robert Rosen

Prince of Wales Hospital Randwick NSW Australia; Southderm Kogarah NSW Australia

Cite This Article

Patrick A. Ireland, Luca Borruso, Sascha K. R. Spencer, et al. (2023). Direct oral anticoagulants in skin surgery: a systematic review of their complications and recommendations for perioperative management. International Journal of Dermatology, 63(4), 413-421. https://doi.org/10.1111/ijd.16916

Direct oral anticoagulants in skin surgery: a systematic review of their complications and recommendations for perioperative management

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