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Scherer FD, Dressler C, Avila Valles G, Nast A. Komplikationsrisiken im Zusammenhang mit Antithrombotika bei Hautoperationen: Systematischer Review und Metaanalyse. J Dtsch Dermatol Ges 2021; 19:1421-1433. [PMID: 34661363 DOI: 10.1111/ddg.14579_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Fabian David Scherer
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venereologie und Allergologie, Charité - Universitätsmedizin Berlin, Gemeinsame Einrichtung der Freien Universität Berlin, Humboldt-Universität zu Berlin und dem Berlin Institute of Health, Berlin
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venereologie und Allergologie, Charité - Universitätsmedizin Berlin, Gemeinsame Einrichtung der Freien Universität Berlin, Humboldt-Universität zu Berlin und dem Berlin Institute of Health, Berlin
| | - Gabriela Avila Valles
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venereologie und Allergologie, Charité - Universitätsmedizin Berlin, Gemeinsame Einrichtung der Freien Universität Berlin, Humboldt-Universität zu Berlin und dem Berlin Institute of Health, Berlin
| | - Alexander Nast
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venereologie und Allergologie, Charité - Universitätsmedizin Berlin, Gemeinsame Einrichtung der Freien Universität Berlin, Humboldt-Universität zu Berlin und dem Berlin Institute of Health, Berlin
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Scherer FD, Dressler C, Valles GA, Nast A. Risk of complications due to antithrombotic agents in cutaneous surgery: a systematic review and meta-analysis. J Dtsch Dermatol Ges 2021; 19:1421-1432. [PMID: 34596345 DOI: 10.1111/ddg.14579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/01/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES We aimed to determine the risk of complications during cutaneous surgery for the perioperative discontinuation in comparison to the continuation of antithrombotic agents and the bridging of vitamin K antagonists with heparin in comparison to their continuation. METHODS We conducted a systematic review, searching three databases for eligible studies. Methods followed the Cochrane Handbook. We used RoB 2 and ROBINS-I to assess risk of bias. The quality of evidence was judged (GRADE). Fixed-effect meta-analyses were performed. RESULTS Two randomized-controlled trials and 19 prospective cohort studies were included. It is uncertain whether, compared to its discontinuation, continuing acetylsalicylic acid (risk difference (RD) 0.004, 95 % confidence interval (CI) -0.003 to 0.019) perioperatively increases the risk of significant postoperative bleedings (SPB). Compared to its discontinuation, continuing phenprocoumon perioperatively may increase the risk of SPB (RD 0.02, 95 % CI 0.00 to 0.05). Bridging phenprocoumon with heparin perioperatively may increase the risk of SPB when compared to its continuation (RD 0.07, 95 % CI 0.01 to 0.22). No evidence was found regarding bleeding risks for direct oral anticoagulants. CONCLUSIONS No clear indications of major risks of bleedings when continuing antithrombotic agents during minor skin surgeries were identified. However, the quality of evidence was very low.
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Affiliation(s)
- Fabian David Scherer
- Division of Evidence-Based Medicine, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gabriela Avila Valles
- Division of Evidence-Based Medicine, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Bonadurer GF, Langeveld AP, Lalla SC, Roenigk RK, Arpey CJ, Otley CC, Baum CL, Trzasko LCO, Brewer JD. Hemorrhagic complications of cutaneous surgery for patients taking antithrombotic therapy: a systematic review and meta-analysis. Arch Dermatol Res 2021; 314:533-540. [PMID: 34132885 DOI: 10.1007/s00403-021-02250-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
Cutaneous operations are generally safe procedures with minimal major risks. Excessive bleeding occasionally occurs, especially for patients taking antithrombotic medications. Conversely, stopping these medications before cutaneous surgery may increase the risk of a thromboembolic event. We aimed to synthesize the evidence regarding the risk of hemorrhage and thromboembolic events for patients undergoing cutaneous surgery while taking antithrombotic therapy. We performed a comprehensive search to identify randomized controlled trials and cohort studies that compared rates of hemorrhage and/or thromboembolic events between patients receiving antithrombotic therapy at cutaneous surgery and patients not receiving it. Odds ratio (OR) and risk difference for complications were calculated with random-effects models. Of 9214 patients taking anticoagulant or antiplatelet medications, 323 (3.5%) had hemorrhagic complications; of 21,696 control patients, 265 (1.2%) had hemorrhagic complications. Patients taking antithrombotic therapy had increased bleeding risk relative to control patients (OR 2.63 [95% CI 1.90-3.63]; P < 0.001) and an increased but less clinically important risk difference (OR 0.02 [95% CI 0.01-0.03]; P < 0.001) with high heterogeneity. No difference was observed in hemorrhage rates among patients whose antithrombotic therapy was stopped vs continued (OR 1.16 [95% CI 0.73-1.83]; P = 0.54). No difference was seen in rates of thromboembolic events among patients taking antithrombotic therapy vs control patients. However, two serious thromboembolic events were noted in a cohort of 59 patients whose antithrombotic therapy was stopped. Because of potentially devastating effects of thromboembolic events, the current accepted practice is indicated for continuation of antithrombotic therapy for patients undergoing cutaneous surgery.
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Affiliation(s)
- George F Bonadurer
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Andrea P Langeveld
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Soogan C Lalla
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,NYC Health and Hospitals, Central Office Division, 55 Water St, New York, NY, 10041, USA
| | - Randall K Roenigk
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christopher J Arpey
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Clark C Otley
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christian L Baum
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Winsett F, Gleghorn K, Croley J, Wagner RF. Managing pain associated with dermatologic procedures. Int J Dermatol 2021; 60:e480-e485. [PMID: 33739460 DOI: 10.1111/ijd.15540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
Dermatologists are faced with an aging population, accompanied by an increase in the incidence of skin cancer, especially nonmelanoma skin cancer. With this increase in cutaneous malignancy comes an increase in the number of dermatologic procedures being performed. A common concern of dermatologists and dermatology patients is the attenuation and management of pain associated with dermatologic procedures. Fortunately, there are several techniques that may be used in the preoperative, intraoperative, and postoperative periods to manage patient anxiety, minimize injection pain, and safely and effectively treat postoperative pain.
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Affiliation(s)
- Frank Winsett
- Department of Dermatology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Kristyna Gleghorn
- Department of Dermatology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Julie Croley
- Department of Dermatology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Richard F Wagner
- Department of Dermatology, The University of Texas Medical Branch, Galveston, Texas, USA
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Update and Review of Bleeding Considerations in Dermatologic Surgery: Anticoagulants and Antiplatelets. Dermatol Surg 2020; 46:192-201. [PMID: 31743247 DOI: 10.1097/dss.0000000000002266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bleeding is an unavoidable risk of dermatologic surgery. The risk may be higher in patients taking agents that affect hemostasis. OBJECTIVE The aim of this study was to provide an updated review of current anticoagulant and antiplatelet therapy available in the market and their associated risk of bleeding complications in cutaneous surgery. MATERIALS AND METHODS A review of PubMed and MEDLINE was performed to review the English-language medical literature. RESULTS Many anticoagulant and antiplatelet therapies exist. Several studies recommend the continued use of antiplatelet and anticoagulant medications in the perioperative period. Combination regimens and novel oral anticoagulants may be associated with an increased risk of bleeding. CONCLUSION An updated understanding of antiplatelet and anticoagulant agents is critical for the surgeon. Current evidence does not support the discontinuation of antiplatelet and anticoagulant agents in the perioperative period under most circumstances. However, relevant data on novel oral anticoagulant agents are still sparse, suggesting that a precautionary approach is warranted.
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Forsyth MG, Clarkson DJ, O’Boyle CP. A systematic review of the risk of postoperative bleeding with perioperative non-steroidal anti-inflammatory drugs (NSAIDs) in plastic surgery. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1410-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Isted A, Cooper L, Colville RJ. Bleeding on the cutting edge: A systematic review of anticoagulant and antiplatelet continuation in minor cutaneous surgery. J Plast Reconstr Aesthet Surg 2018; 71:455-467. [DOI: 10.1016/j.bjps.2017.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/24/2017] [Accepted: 11/10/2017] [Indexed: 11/16/2022]
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Effect of Drugs Associated With Bleeding Tendency on the Complications and Outcomes of Transforaminal Epidural Steroid Injection. Clin Spine Surg 2017; 30:E104-E110. [PMID: 27623303 DOI: 10.1097/bsd.0000000000000425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This is a retrospective case-control study. OBJECTIVE To evaluate the influence of medication-related bleeding tendency on the clinical outcomes and complications of transforaminal epidural steroid injection (TFESI). SUMMARY OF BACKGROUND DATA TFESI may result in serious complications such as epidural hematoma or adhesions in patients with medication-related bleeding tendency. However, little is known about the true relationship between medication-related bleeding tendency and postprocedural complications. METHODS Retrospective review of the medical records of patients who had TFESI from 2010 to 2014 was done. Commonly used medications such as warfarin, heparin, aspirin, clopidogrel, and Opalmon (limaprost alfadex) were included as medications associated with bleeding tendency. Patients were divided into 3 groups and the treatment outcomes for each group were compared: The first group used medications associated with bleeding tendency, but discontinued them in due time before the procedure (discontinued group). The second group used medications associated with bleeding tendency and continued receiving medication (continuing group). The third group did not use any medications associated with a bleeding tendency (nonmedicated group). RESULTS Among 2,469 patients, 1,234 were in the discontinued group, 408 patients in the continuing group, and 827 patients in the nonmedicated group. There were no statistically significant differences between groups for the treatment outcomes such as the degree of pain relief, duration of improvement, and complication rates including symptomatic epidural hematoma. Moreover, for the discontinued group and continuing group, the treatment outcomes were compared among patients with same medication, and revealed no differences. CONCLUSIONS This study demonstrated that continued use of medications associated with bleeding tendency does not increase epidural hematoma or symptomatic exacerbation, and thus should not be considered as a contraindication for TFESI. LEVEL OF EVIDENCE Level 3.
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Burkett BN, Thomason JM, Hurdle HM, Wills RW, Fontenot RL. Effects of Firocoxib, Flunixin Meglumine, and Phenylbutazone on Platelet Function and Thromboxane Synthesis in Healthy Horses. Vet Surg 2016; 45:1087-1094. [PMID: 27731498 DOI: 10.1111/vsu.12567] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Determine the effects of nonsteroidal anti-inflammatory drugs (NSAID) on platelet function and thromboxane synthesis immediately after drug administration and following 5 days of NSAID administration in healthy horses. STUDY DESIGN Randomized cross-over study. ANIMALS Healthy adult horses (n=9; 6 geldings and 3 mares). METHODS Horses received either flunixin meglumine (1.1 mg/kg IV every 12 hours), phenylbutazone (2.2 mg/kg IV every 12 hours), or firocoxib (loading dose of 0.27 mg/kg IV on day 1, then 0.09 mg/kg IV every 24 hours for 4 days) for a total of 5 days. Blood samples were collected prior to drug administration (day 0), 1 hour after initial NSAID administration (day 1), and then 1 hour post-NSAID administration on day 5. Platelet function was assessed using turbidimetric aggregometry and a platelet function analyzer. Serum thromboxane B2 concentrations were determined by commercial ELISA kit. A minimum 14 day washout period occurred between trials. RESULTS At 1 hour and 5 days postadministration of firocoxib, flunixin meglumine, or phenylbutazone, there was no significant effect on platelet aggregation or function using turbidimetric aggregometry or a platelet function analyzer. There was, however, a significant decrease in thromboxane synthesis at 1 hour and 5 days postadministration of flunixin meglumine and phenylbutazone that was not seen with firocoxib. CONCLUSION Preoperative administration of flunixin meglumine, phenylbutazone, or firocoxib should not inhibit platelet function based on our model. The clinical implications of decreased thromboxane B2 synthesis following flunixin meglumine and phenylbutazone administration are undetermined.
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Affiliation(s)
- Brenna N Burkett
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Holly M Hurdle
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Robert W Wills
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Robin L Fontenot
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi.
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Kumar KA, Kumar J, Sarvagna J, Gadde P, Chikkaboriah S. Hemostasis and Post-operative Care of Oral Surgical Wounds by Hemcon Dental Dressing in Patients on Oral Anticoagulant Therapy: A Split Mouth Randomized Controlled Clinical Trial. J Clin Diagn Res 2016; 10:ZC37-ZC40. [PMID: 27790577 PMCID: PMC5072077 DOI: 10.7860/jcdr/2016/17275.8462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hemostasis is a fundamental management issue post-operatively in minor oral surgical procedures. To ensure safety and therapeutic efficacy in patients, under oral anti coagulant therapy, is complicated by necessity for frequent determination of prothrombin time or international normalised ratio. AIM The aim of the study was to determine whether early hemostasis achieved by using Hemcon Dental Dressing (HDD) will affect post-operative care and surgical healing outcome in minor oral surgical procedures. MATERIALS AND METHODS A total of 30 patients, aged 18 years to 90 years, except those allergic to seafood, who consented to participate, were enrolled into this study. Patients were required to have two or more surgical sites so that they would have both surgical and control sites. All patients taking Oral Anticoagulation Therapy (OAT) were included for treatment in the study without altering the anticoagulant regimens. Institutional Review Board approval was obtained for the same. The collected data was subjected to statistical analysis using unpaired t-test. RESULTS All HDD surgically treated sites achieved hemostasis in 1.49 minutes and control wounds in 4.06 minutes (p < 0.001). Post-operative pain at HDD treated sites (1.87,1.27 on 1st and 3rd day respectively) was significantly lower than the control sites (4.0,1.87 on 1st and 3rd day respectively) p-value (0.001, 0.001 respectively). HDD treated oral surgery wounds achieved statistically significant improved healing both at 1st and 3rd post-operative days (p <0.0001). CONCLUSION The HDD has been proven to be a clinically effective hemostatic dressing material that significantly shortens bleeding time following minor oral surgical procedures under local anaesthesia, including those patients taking OAT. Patients receiving the HDD had improved surgical wound healing as compared to controls.
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Affiliation(s)
- K.R. Ashok Kumar
- Head of the Department, Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College, Tumkur, Karnataka, India
| | - Jambukeshwar Kumar
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Vishnu Dental Collage, Bhimavaram, Andhra Pradesh, India
| | - Jagadesh Sarvagna
- Consultant Oral Oncologist, Siddhagiri Hospital, Kolhapur, Maharashtra, India
| | - Praveen Gadde
- Senior Lecturer, Department of Public Health Dentistry, Vishnu Dental College, Bhimavaram, Andhrapradesh, India
| | - Shwetha Chikkaboriah
- Postgraduate, Department of Periodontics, Vakkaligara Sanga Dental College, Bangalore, Karnataka, India
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Acute pain management in dermatology. J Am Acad Dermatol 2015; 73:543-60; quiz 561-2. [DOI: 10.1016/j.jaad.2015.04.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 02/02/2023]
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Sporbeck B, Bechara FG, Häfner HM, Koenen W, Kolk A, Koscielny J, Meissner M, Pokrywka A, Schirmer S, Strömer K, Löser C, Nast A. S3-Leitlinie zum Umgang mit Antikoagulation bei Operationen an der Haut. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12576_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Birte Sporbeck
- Division of Evidence Based Medicine, Charité - Universitätsmedizin Berlin
| | | | | | | | - Andreas Kolk
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum rechts der Isar, Technische Universität München
| | - Jürgen Koscielny
- Institut für Transfusionsmedizin, Charité - Universitätsmedizin Berlin
| | - Markus Meissner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt
| | - Anna Pokrywka
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - Steffen Schirmer
- Klinik für Plastische, Wiederherstellungs- und Ästhetische Chirurgie - Handchirurgie, Klinikum Bielefeld Mitte
| | - Klaus Strömer
- Niedergelassene Dermatologe, Gemeinschaftspraxis Dr. Strömer / Deden, Mönchengladbach
| | - Christoph Löser
- Hautklinik, Hauttumorzentrum, Klinikum der Stadt Ludwigshafen am Rhein gGmbH
| | - Alexander Nast
- Division of Evidence Based Medicine, Charité - Universitätsmedizin Berlin
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Sporbeck B, Georges Bechara F, Häfner HM, Koenen W, Kolk A, Koscielny J, Meissner M, Pokrywka A, Schirmer S, Strömer K, Löser C, Nast A. S3 guidelines for the management of anticoagulation in cutaneous surgery. J Dtsch Dermatol Ges 2015; 13:346-56. [PMID: 25819254 DOI: 10.1111/ddg.12576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND An increasing number of patients are being treated with anticoagulants and platelet inhibitors. Whenever surgical procedures of the skin are required, questions arise regarding the perioperative management of anticoagulation. METHODS Development of S3 guidelines following the requirements of the Association of Scientific Medical Societies, systematic literature search and analysis, use of GRADE methodology, structured consensus conference using a nominal group process. RESULTS During cutaneous surgery, treatment with acetylsalicylic acid (ASA) should be continued if medically necessary. In procedures with a higher risk of bleeding and a positive bleeding history, INR should be determined preoperatively. Surgical procedures of the skin with a higher risk of bleeding should not be performed if the INR is above therapeutic range. Bridging from vitamin K antagonists (VKA) to heparin should not be performed just because of the surgery of the skin. As to direct-acting oral anticoagulants, the last dose should be taken 24 h preoperatively. CONCLUSIONS The recommendations issued by the German guidelines group are mostly in line with recommendations provided by other guidelines. The American ìChest-Guidelineì recommends continuing VKAs and acetylsalicylic acid during minor dermatologic procedures. In their guidelines, the German College of General Practitioners and Family Physicians considers an INR of 2 to be adequate in surgical procedures on the skin.
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Affiliation(s)
- Birte Sporbeck
- Division of Evidence Based Medicine, Charité - Universitätsmedizin Berlin
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Darawade DA, Kumar S, Desai K, Hasan B, Mansata AV. Influence of aspirin on post-extraction bleeding - A clinical study. J Int Soc Prev Community Dent 2014; 4:S63-7. [PMID: 25452931 PMCID: PMC4247554 DOI: 10.4103/2231-0762.144602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Aim: The aim of the study was to evaluate the influence of aspirin on post-extraction bleeding in a clinical setup. Materials and Methods: Two hundred patients aged between 50 and 65 years who were indicated for dental extraction for endodontic reason were selected from the outpatient Department of Oral and Maxillofacial Surgery. The patients were randomly divided into aspirin continuing group (group A) and aspirin discontinuing group (group B). After checking all the vital signs, the extractions were carried out. Bleeding time and clotting time were recorded for evaluation by Chi-square test. Results: Chi-square test revealed that the bleeding time increased (3.8 ± 0.75) in group A patients continued with the aspirin therapy where as group B discontinued aspirin. Similarly, the clotting time increased in group B patients and decreased in group A patients. But in both the groups, bleeding and clotting time remained within normal limits. Conclusion: Reviewing most of the dental and medical literature, it can be concluded that there is absolutely no need to discontinue antiplatelet therapy for any ambulatory dental procedure, and even if the practitioner wishes to discontinue, it should not be for more than 3 daAQ2ys. This is also stated in the guidelines of the American Heart Association.
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Affiliation(s)
- Dattatraya A Darawade
- Department of Oral and Maxillofacial Surgery, Rungta College of Dental Sciences, Bhilai, Chattisgarh, India
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Gandhinagar, Gujarat, India
| | - Khushboo Desai
- Department of Periodontology, Karnavati School of Dentistry, Gandhinagar, Gujarat, India
| | - Basit Hasan
- Department of Conservative Dentistry and Endodontics, RKDF Dental College and Research Centre, Bhopal, Madhya Pradesh, India
| | - Anuj Vasantray Mansata
- Department of Oral and Maxillofacial Pathology, Karnavati School of Dentistry, Gandhinagar, Gujarat, India
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Nast A, Ernst H, Rosumeck S, Erdmann R, Jacobs A, Sporbeck B. Risk of complications due to anticoagulation during dermatosurgical procedures: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2014; 28:1603-9. [PMID: 25132203 DOI: 10.1111/jdv.12611] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 05/26/2014] [Indexed: 01/22/2023]
Abstract
Background Management of anticoagulation and anti-platelet drugs during cutaneous surgery is still a challenge for many dermatologists and standards of care with respect to stopping, continuing or bridging vary widely. Methods We performed a systematic review (Medline, Cochrane Library, until August 27th, 2013) of studies assessing the risk of complications due to anticoagulation during cutaneous surgery. Primary outcomes were mild-moderate and severe postsurgical bleeding. The secondary outcomes were excessive and uncontrollable intraoperative bleeding and other postsurgical complications as wound dehiscence, erythema, wound infection. Results 1.287 publications were identified and 10 studies were included into the review. The frequencies of bleeding in the control groups in general were low (about 1%). In patients on aspirin, increased risks were seen neither with respect to mild-moderate postoperative bleeding (RR 1.1, CI 0.5-2.3), nor with respect to severe bleeding (RR 0.9, CI 0.2-4.6). The studies with patients on warfarin showed a risk for mild-moderate bleeding that was three times as high as in controls (RR 3.2, CI 1.4-7.1) and for severe bleeding that was 15 times higher (RR 14.8, CI 2.7-80.4). In general the study sizes were small and the methodological quality low. Conclusion The risk of bleeding due to a medication with aspirin seems to be negligible. With warfarin, the risk is increased; an exact estimate of the risk increase is difficult to give, because of the lack of sufficient high quality studies. A two-fold increase appears likely, the 15-fold increase is most likely due to statistical reasons arising from the rareness of the event in the small number of included patients. Stopping, bridging or continuing a medication should always be an individual decision. In accordance with guidelines from internal medicine for most patients it will be recommendable to continue with the medication.
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Affiliation(s)
- A Nast
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Shetty S, K S, Thomas B, Shetty N, Shetty A, Shetty D. NSAIDs and bleeding in periodontal surgery. J Clin Diagn Res 2014; 8:ZC17-20. [PMID: 24995237 PMCID: PMC4080058 DOI: 10.7860/jcdr/2014/7805.4344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 02/12/2014] [Indexed: 11/24/2022]
Abstract
AIM To evaluate and compare the clinical effects of ibuprofen and diclofenac sodium on bleeding during periodontal surgery. MATERIALS AND METHODS Thirteen medically healthy men and women of mean age 37.5±17.67 (mean age± standard deviation) were selected for the study. All the subjects were divided into three groups: control (C) and test groups (T1) and (T2). Each subject of T1 group and T2 group was given ibuprofen and diclofenac sodium respectively, prior to surgery. Bleeding times of patients were recorded prior to performance of periodontal flap surgical procedures. RESULTS It was found that there was increased bleeding time and increased peri-operative bleeding when ibuprofen and diclofenac sodium were taken prior to surgery and this was statistically significant. (2.5538 (T1), 1.8385 (T2) versus 1.2385 (C) minute, p= .001) (mean blood loss) and (62.0325 ± 9.0594 (T1), 51.082 ± 9.792 (T2) versus 37.4992 ± 5.99 (C) millilitre, p = .000). CONCLUSION The findings of this study suggested that pre-operative administration of ibuprofen and diclofenac sodium could increase bleeding time and peri - operative blood loss.
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Affiliation(s)
- Sanyuktha Shetty
- Senior Lecturer, Department of Periodontics, Dr. D.Y. Patil Dental College & Hospital, Nerul, Navi Mumbai, India
| | - Sharath K
- Professor and Head, Department of Periodontics, Srinivas Institute of Dental Sciences, Mukka, Karnataka, India
| | - Biju Thomas
- Professor and Head, Department of Periodontics, A.B. Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore, Karnataka, India
| | - Nitin Shetty
- Senior Lecturer, Department of Prosthodontics, Dr. D.Y. Patil Dental College & Hospital, Nerul, Navi Mumbai, India
| | - Arvind Shetty
- Professor and Head, Department of Periodontics, Dr. D.Y. Patil Dental College & Hospital, Nerul, Navi Mumbai, India
| | - Devanand Shetty
- Professor, Department of Periodontics, Dr. D.Y. Patil Dental College & Hospital, Nerul, Navi Mumbai, India
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Dental extraction can be performed safely in patients on aspirin therapy: a timely reminder. ISRN DENTISTRY 2014; 2014:463684. [PMID: 25093121 PMCID: PMC4004018 DOI: 10.1155/2014/463684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/16/2014] [Indexed: 12/01/2022]
Abstract
Cardiac patients on aspirin therapy may require extractions for their diseased teeth. It is a common practice among physicians and treating surgeons to stop aspirin prior to tooth extraction because of fear of bleeding complications. This practice often predisposes the patient to adverse thromboembolic events. This practice is based on theoretical risk of bleeding and on isolated case reports of excessive bleeding with aspirin therapy. The current consensus and recommendations are in favor of continuing aspirin therapy during simple tooth extraction as the bleeding complication incidence is very less and if it occurs can be controlled efficiently with local hemostasis measures.
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Lee J, Kim JK, Kim JH, Dunuu T, Park SH, Park SJ, Kang JY, Choi RK, Hyon MS. Recovery time of platelet function after aspirin withdrawal. Curr Ther Res Clin Exp 2014; 76:26-31. [PMID: 25031665 PMCID: PMC4008770 DOI: 10.1016/j.curtheres.2014.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 01/15/2023] Open
Abstract
Introduction Inappropriate antiplatelet therapy discontinuation increases the risk of thrombotic complications and bleeding after dental procedures. To determine the platelet reactivity recovery time after aspirin withdrawal in vivo, our study was conducted in patients with low-risk cardiovascular disease who can stop aspirin administration following the guidelines stipulated by the American College of Chest Physicians. The time it takes for platelet activity to normalize and the diagnostic accuracy of testing methods were assessed for a residual antiplatelet activity with multiple electrode aggregometry. Our study included patients with clinically indicated hypertension preparing for a dental extraction procedure. Materials and methods A total of 212 patients not taking aspirin (control group) and 248 patients with hypertension receiving long-time aspirin treatment at a 100-mg daily dose were prospectively included in the study, which involved stopping aspirin intake before dental extraction. The residual platelet activity and dental bleeding in patients who stopped aspirin intake were analyzed and compared with those of the control group. In addition, platelet reactivity recovery time and bleeding risk in patients who stopped taking aspirin every 24 hours for 0 to 5 days (0–143 hours) before dental extraction was also assessed. Results Platelet reactivity normalized 96 hours after aspirin withdrawal. The cut-off value of 49 arbitrary units in the arachidonic acid platelet aggregation test excluded the effect of aspirin with 91% sensitivity and 66% specificity. AUC showed 0.86 (P < 0.001) diagnostic accuracy. The immediate bleeding complications in all treatment groups were similar to those seen in the control group and were successfully managed with local hemostatic measures. Conclusions The antiplatelet effects of aspirin disappeared 96 hours after aspirin withdrawal in our study, and dental extractions may be safely performed in this period when appropriate local hemostatic measures are taken. Based on these results, a shorter aspirin intake cessation period may be allowable in complex dental procedures and surgery for which a longer aspirin intake cessation period (7–10 days) is recommended based on the American College of Chest Physicians guidelines.
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Affiliation(s)
- Jeonghun Lee
- Cardiovascular Interventional Center, Sun General Hospital, Daejeon, Korea
| | - Jeong Kyung Kim
- Cardiovascular Interventional Center, Sun General Hospital, Daejeon, Korea
| | - Jeong Hee Kim
- Cardiovascular Interventional Center, Sun General Hospital, Daejeon, Korea
| | - Tsagaan Dunuu
- Intensive Care Unit and Department of Emergency, Shastin Central Hospital, Ulaanbaatar, Mongolia
| | - Sang-Ho Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sang Joon Park
- Interventional Radiology, Department of Radiology, Sun General Hospital, Daejeon, Korea
| | - Ji Yeon Kang
- Department of Oral and Maxillofacial Surgery, Sun General Hospital, Daejeon, Korea
| | - Rak Kyeong Choi
- Cardiovascular Division of Internal Medicine, Bucheon Sejong General Hospital, Bucheon, Korea
| | - Min Su Hyon
- Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cardiovascular Institution, Seoul, Korea
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Abstract
Cyclooxygenase-2 specific inhibitors have anti-inflammatory and analgesic properties, and are effective in managing a wide range of chronic and acute painful conditions such as adult rheumatoid arthritis, osteoarthritis, migraine, primary dysmenorrhea and postoperative pain. Valdecoxib, an orally administered cyclooxygenase-2 specific inhibitor, provides effective pain relief for both chronic and acute conditions, and reduces postoperative opioid use, with a concomitant reduction in opioid-related adverse events. Valdecoxib also has superior gastrointestinal safety compared with nonspecific nonsteroidal anti-inflammatory drugs, and at therapeutic doses, it is generally safe and well tolerated in terms of renal and cardiovascular events. This drug profile reviews the efficacy, safety and tolerability of valdecoxib for the management of chronic and acute pain.
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Affiliation(s)
- Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 9068, USA.
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20
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Loomba A, Loomba K, Bains R, Bains VK. Management of a dentigerous cyst in a medically compromised geriatric patient: a case report. Gerodontology 2012; 29:e1190-4. [PMID: 22612836 DOI: 10.1111/j.1741-2358.2011.00576.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Because of the increasing number of older persons seeking dental care, the growing trend towards a longer dental appointment and increased administration of drugs in dentistry, the possibility of occurrence of medical emergencies in dental offices has shown an upward trend. OBJECTIVE This case report discusses enucleation of a central dentigerous cyst in a 72-year old male on long-term low dose aspirin therapy. MATERIAL AND METHODS Surgical removal of impacted tooth with total enucleation of cystic lesion was performed in the dental chair under 2% lidocaine with 1:200,000 adrenaline, 3 days after aspirin cessation. After complete debridement of the surgical site, the wound was sutured and a gauge saturated with 10% tranexamic acid was placed on surgical site for 30 minutes. RESULT No post-operative complications or bleeding was seen on subsequent appointment and healing was normal. CONCLUSION A geriatric and medically compromised patient demands special care and attention; and the decision to cease aspirin before surgery or not is of critical importance.
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Affiliation(s)
- Anju Loomba
- Department of Orthodontics and Dentofacial Orthopedics, Saraswati Dental College and Hospital, Lucknow (UP), India
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21
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Park MW, Her SH, Kwon JB, Lee JB, Choi MS, Cho JS, Kim DB, Chung WS, Seung KB, Kim KY. Safety of dental extractions in coronary drug-eluting stenting patients without stopping multiple antiplatelet agents. Clin Cardiol 2012; 35:225-30. [PMID: 22278596 DOI: 10.1002/clc.21960] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/22/2011] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The risk of excessive bleeding prompts physicians to stop multiple antiplatelet agents before minor surgery, which puts coronary stenting patients at risk for adverse thrombotic events. HYPOTHESIS We hypothesized that most dental extractions can be carried out safely without stopping multiple antiplatelet agents. METHODS All dental extraction patients who had undergone coronary stenting and who were also on oral multiple antiplatelet agents therapy were enrolled. One hundred patients underwent dental procedures without stopping antiplatelet agents. All wounds were sutured and followed up at 24 hours, 1 week, and 1 month after the procedure. There were 2233 patients who had not taken oral antiplatelet agents from a health promotion center and had teeth extracted by the same method. After performing propensity-score matching for the entire population, a total of 100 matched pairs of patients were created. The primary outcome was a composite of excessive intraextraction blood loss, transfusion, and rehospitalization for bleeding, and the secondary outcome was a composite of death, nonfatal myocardial infarction, target lesion revascularization, and stent thrombosis within 1 month after the procedure. RESULTS There were 2 excessive intraextraction bleeding cases that continued at the extraction site for 4 and 5 hours, respectively, in the coronary stenting patients, and 1 excessive intraextraction bleeding case that continued for 3 hours in the control patients. There were no cases of transfusion, rehospitalization for bleeding, or major cardiovascular events for the 2 propensity-matched groups. CONCLUSIONS We found that most dental extractions in coronary stenting patients can be carried out safely without stopping multiple antiplatelet agents.
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Affiliation(s)
- Mahn-Won Park
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, South Korea
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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; 65:576-583. [PMID: 21782278 DOI: 10.1016/j.jaad.2011.02.012] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 01/12/2011] [Accepted: 02/23/2011] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | | | - Dori Goldberg
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sean F Pattee
- Dermatology Associates of Wisconsin, Manitowoc, Wisconsin
| | - Pingfu Fu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mary E Maloney
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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23
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Jámbor C, von Pape KW, Spannagl M, Dietrich W, Giebl A, Weisser H. Multiple electrode whole blood aggregometry, PFA-100, and in vivo bleeding time for the point-of-care assessment of aspirin-induced platelet dysfunction in the preoperative setting. Anesth Analg 2011; 113:31-9. [PMID: 21519054 DOI: 10.1213/ane.0b013e31821acddc] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acquired platelet dysfunction due to aspirin ingestion may increase bleeding tendency during surgery. Thus, we examined the diagnostic accuracy of in vivo bleeding time (BT) and 2 platelet function assays for the preoperative assessment of a residual antiplatelet effect in patients treated with aspirin. METHODS Consecutive patients scheduled for surgery were prospectively enrolled in this study. The patients' last aspirin ingestion had occurred within the previous 48 hours before blood sampling in the "full aspirin effect" group, between 48 and 96 hours before in the "variable aspirin effect" group, and >96 hours before in the "recovered aspirin effect" group. The control group had not taken any aspirin. Multiple electrode aggregometry, platelet function analyzer (PFA)-100, and in vivo BT were performed to assess the effects of aspirin. One-way analysis of variance on ranks with a post hoc multiple-comparison procedure (Dunn) was used to detect differences among the groups. Categorical data were compared using the z test. Receiver operating characteristic (ROC) curves were created to determine the diagnostic accuracy of the platelet function assays investigated. The area under the ROC curve (AUC), sensitivity, and specificity of the assays were calculated. The level of statistical significance was set at P < 0.05. RESULTS Three hundred ninety-four patients were included in the analysis (133 control and 261 aspirin-treated patients). All 3 methods were able to detect the antiplatelet effect of aspirin in the full aspirin effect group. Furthermore, no difference in the measurement values between the recovered aspirin effect and control group was found, irrespective of the assay performed. Measurement values in the variable aspirin effect group were different from those of the control group in the ASPItest using multiple electrode aggregometry and COL-EPI using PFA-100 but not in BT. ROC analysis showed the highest diagnostic accuracy in excluding the residual aspirin effect in the ASPItest (AUC 0.81, P < 0.001), followed by COL-EPI (AUC 0.78, P < 0.001) and BT (AUC 0.56, P = 0.05). The cutoff value of 53 U in the ASPItest excluded the effect of aspirin with a sensitivity of 88% and specificity of 71%. CONCLUSIONS The full therapeutic antiplatelet effects of aspirin can be expected within 48 hours of the patient's last aspirin ingestion. Platelet function recovered in our study if aspirin cessation occurred >96 hours (4 days) before; thus, in these patients, preoperative platelet function testing is not useful. To quantify any residual aspirin effect in patients who ceased their intake of aspirin between 48 and 96 hours before surgery, the ASPItest might have the highest diagnostic accuracy.
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Affiliation(s)
- Csilla Jámbor
- Clinic for Anesthesiology, Working Group Perioperative Haemostasis, University of Munich, Max-Lebsche-Platz 32, D-81377 Munich, Germany.
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Bilan de l’activité de chirurgie d’exérèse des tumeurs cutanées en dermatologie en France en 2009. Ann Dermatol Venereol 2011; 138:100-6. [DOI: 10.1016/j.annder.2011.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 12/14/2010] [Accepted: 01/03/2011] [Indexed: 11/20/2022]
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25
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Václavík J, Táborský M. Antiplatelet therapy in the perioperative period. Eur J Intern Med 2011; 22:26-31. [PMID: 21238889 DOI: 10.1016/j.ejim.2010.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 10/01/2010] [Accepted: 10/25/2010] [Indexed: 12/22/2022]
Abstract
The current practice of withdrawing aspirin 7-10 days preoperatively may be dangerous in certain groups of patients. The risk of cardiovascular events increases 3-fold after aspirin withdrawal. The average time between aspirin withdrawal and the manifestation of acute coronary syndrome is 8 to 11 days. The withdrawal of clopidogrel earlier than 4-6 weeks after bare metal stent implantation or less than 12 months after drug-eluting stent implantation is very risky and poses a high risk of stent thrombosis and high perioperative mortality. Continuing aspirin perioperatively leads to a 1.5-fold increase in perioperative bleeding complications but it does not lead to a higher severity of bleeding complications or higher mortality. The article analyzes current European and American guidelines for perioperative antiplatelet treatment and suggests an algorithm based on the guidelines to help make clinical decisions.
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Affiliation(s)
- Jan Václavík
- Department of Internal Medicine I-Cardiology, University Hospital Olomouc and Palacký University Faculty of Medicine, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic.
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26
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Jámbor C, Weber CF, Gerhardt K, Dietrich W, Spannagl M, Heindl B, Zwissler B. Whole Blood Multiple Electrode Aggregometry Is a Reliable Point-of-Care Test of Aspirin-Induced Platelet Dysfunction. Anesth Analg 2009; 109:25-31. [DOI: 10.1213/ane.0b013e3181a27d10] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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27
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Cox NH, Walsh ML, Robson RH. Purpura and bleeding due to calcium-channel blockers: an underestimated problem? Case reports and a pilot study. Clin Exp Dermatol 2009; 34:487-91. [DOI: 10.1111/j.1365-2230.2008.03048.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Surgical complications. Dermatol Surg 2009. [DOI: 10.1016/b978-0-7020-3049-9.00017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Bassas P, Bartralot R, García-Patos V. Anticoagulation and Antiplatelet Therapy in Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Hurst EA, Yu SS, Grekin RC, Neuhaus IM. Bleeding complications in dermatologic surgery. ACTA ACUST UNITED AC 2008; 26:189-95. [PMID: 18395666 DOI: 10.1016/j.sder.2008.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although the overall incidence is low, bleeding complications in dermatologic surgery can occur and be the source of significant patient morbidity. In this article, we summarize the key aspects of preoperative assessment of patients at risk for bleeding. A review of current issues and literature regarding safe continuation of anticoagulant and antiplatelet medications in dermatologic surgery patients is also presented. In addition, principles for management of bleeding events, should they occur, are also highlighted.
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Affiliation(s)
- Eva A Hurst
- UCSF Dermatologic Surgery and Laser Center, San Francisco, CA, USA
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Shalom A, Klein D, Friedman T, Westreich M. Lack of Complications in Minor Skin Lesion Excisions in Patients Taking Aspirin or Warfarin Products. Am Surg 2008. [DOI: 10.1177/000313480807400417] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many patients undergoing surgical procedures take medications that influence the coagulation system. It is common practice to discontinue the use of aspirin and warfarin products 7 to 10 days before any major surgical procedure. However, there is some controversy as to whether these medications should be discontinued for minor dermatological procedures. Our aim was to study the incidence of complications in patients receiving aspirin or warfarin and undergoing minor dermatological procedures. Two thousand three hundred twenty-six patients, operated on by a single surgeon, were studied for complications. Warfarin was used by 28 patients, 228 took aspirin, and the remainder took neither. There was no difference in the complication rate among the three groups as long as the surgeon diligently obtained hemostasis. It appears that patients taking aspirin or warfarin do not need to discontinue these medications before minor dermatological procedures.
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Affiliation(s)
- Avshalom Shalom
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Doron Klein
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Tal Friedman
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Melvyn Westreich
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Perioperative Management of Medications for Psoriasis and Psoriatic Arthritis. Dermatol Surg 2008. [DOI: 10.1097/00042728-200804000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hernandez C, Emer J, Robinson JK. Perioperative management of medications for psoriasis and psoriatic arthritis: a review for the dermasurgeon. Dermatol Surg 2008; 34:446-59. [PMID: 18248470 DOI: 10.1111/j.1524-4725.2007.34091.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Psoriasis affects an estimated 3% of the world's population. Many are on chronic immunosuppressive therapy for the cutaneous and joint manifestations of this disorder. The management of these medications in the perioperative period is controversial. Psoriasis and psoriatic arthritis medications can affect wound healing, hemostasis, and infection risk during cutaneous surgery. OBJECTIVES The objective of this article is to provide a critical review of various medications used for care of the psoriatic patient and their potential effect on cutaneous surgical procedures. CONCLUSIONS This review summarizes current understanding of wound healing, hemostatic effects, and infectious risks regarding many psoriasis medications including nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, corticosteroids, various immunosuppressants, and biologic response modifiers. Recommendations vary depending on the agent in question, type of procedure, and comorbid conditions in the patient. Caution is advised when using many of the medications reviewed due to lack of human data of their effects in the perioperative period.
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Affiliation(s)
- Claudia Hernandez
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois 60612-7300, USA
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The Effect of Platelet-Altering Medications on Bleeding From Minor Oral Surgery Procedures. J Oral Maxillofac Surg 2008; 66:93-7. [DOI: 10.1016/j.joms.2005.11.055] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dixon AJ, Dixon MP, Dixon JB. Bleeding complications in skin cancer surgery are associated with warfarin but not aspirin therapy. Br J Surg 2007; 94:1356-60. [PMID: 17654609 DOI: 10.1002/bjs.5864] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim was to identify risk factors for postoperative bleeding following skin cancer surgery. METHODS This was a prospective study of 5950 skin lesions excised in 2394 patients. No patient stopped taking aspirin or warfarin unless the international normalized ratio (INR) exceeded 3.0. RESULTS The rate of postoperative bleeding was 0.7 per cent overall and 2.5 per cent in the 320 patients taking warfarin. The rate of bleeding was 1.0 per cent for skin flap repairs, 0.4 per cent for simple excision and closure, and 5.0 per cent for skin grafts. Diabetic patients and smokers were not at increased risk of bleeding. There were four independent factors for bleeding: age 67 years or older (odds ratio (OR) 4.7 (95 per cent confidence interval 1.8 to 12.2); P = 0.002), warfarin therapy (OR 2.9 (1.4 to 6.3); P = 0.006), surgery on or around the ear (OR 2.6 (1.2 to 5.7); P = 0.012) and closure with a skin flap or graft (OR 2.7 (1.4 to 5.3); P = 0.004). Aspirin therapy was not an independent risk factor for bleeding. CONCLUSION Most postoperative bleeds were inconvenient but not life threatening, unlike the potential risk of thromboembolism after stopping warfarin or aspirin. There was no case for discontinuing aspirin before skin surgery, but the INR should be monitored in patients taking warfarin.
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Affiliation(s)
- A J Dixon
- Skin Alert Skin Cancer Clinics, Belmont, Monash University, Melbourne, Victoria, Australia.
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Abstract
Although the overall incidence is low, bleeding complications in dermatologic surgery can occur and be the source of significant patient morbidity. In this article, we summarize the key aspects of preoperative assessment of patients at risk for bleeding. A review of current issues and literature regarding safe continuation of anticoagulant and antiplatelet medications in dermatologic surgery patients is also presented. In addition, principles for management of bleeding events, should they occur, are also highlighted.
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Affiliation(s)
- Eva A Hurst
- UCSF Dermatologic Surgery and Laser Center, San Francisco, CA 94115, USA
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Armstrong MJ, Schneck MJ, Biller J. Discontinuation of perioperative antiplatelet and anticoagulant therapy in stroke patients. Neurol Clin 2006; 24:607-30. [PMID: 16935191 DOI: 10.1016/j.ncl.2006.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Growing evidence suggests that perioperative withdrawal of ASA for secondary stroke prevention increases thromboembolic risk without the associated benefit of decreased bleeding complications. ASA maintenance is acceptable in many procedures, including invasive ones. Many procedures, in particular ophthalmologic, dermatologic, and dental surgeries, also are safe while continuing oral AC. Warfarin has been continued successfully even in some surgeries that have high bleeding risk. When the risk is too high, temporary bridging therapy with LWMH is safe in many populations. Although the exact thromboembolic risks associated with temporary cessation of AP and AC are unknown and likely low, morbidity and mortality associated with thromboembolism are high. Further studies investigating the risks and benefits of maintaining AP and AC during procedures, particularly invasive ones, are needed. Meanwhile, it is critical that physicians understand the risks and benefits of perioperative AP and AC and the variety of procedures in which these agents can be safely continued.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
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Khalifeh MR, Redett RJ. The Management of Patients on Anticoagulants Prior to Cutaneous Surgery: Case Report of a Thromboembolic Complication, Review of the Literature, and Evidence-Based Recommendations. Plast Reconstr Surg 2006; 118:110e-117e. [PMID: 17016167 DOI: 10.1097/01.prs.0000221114.01290.85] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marwan R Khalifeh
- Baltimore, Md. From the Division of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital
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Destro MWB, Speranzini MB, Destro C, Guerra C, Recco GC, Romagnolo LGC. Estudo da utilização no pré-operatório de medicamentos ou drogas fitoterápicas que alteram a coagulação sangüínea. Rev Col Bras Cir 2006. [DOI: 10.1590/s0100-69912006000200010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Verificar com que freqüência medicamentos e\ou drogas fitoterápicas que interferem na coagulação sangüínea são utilizados por pacientes que serão submetidos à intervenção cirúrgica e cujo uso não é relatado ao cirurgião; ou quando este é informado não se recomenda a sua interrupção antes da operação. MÉTODO: Estudo quantitativo com variáveis qualitativas, transversal, sobre o uso de medicamentos (AAS e Vitamina E) e fitoterápicos (Ginkgo biloba, Alho, Ginseng e Gengibre) por parte de 416 pacientes em programação pré-operatória. Desenvolvido no Hospital Universitário de Taubaté (HUT) no Hospital Regional de Taubaté (HRT) e em um Consultório Particular de Cirurgia Plástica. Estes dados foram obtidos por meio de questionário com perguntas relacionadas ao uso ou não das drogas referidas no último ano e nos 10 dias que antecediam a operação, se o cirurgião foi informado do fato e se houve recomendação médica para a sua suspensão. RESULTADOS: do total pesquisado 58,89% não fizeram uso de alguma das drogas em questão, 39% as usaram no último ano e 13,83% usaram nos últimos 10 dias. O AAS foi o medicamento mais utilizado e dentre os fitoterápicos, o Ginkgo biloba. Do total pesquisado 73,69% dos pacientes não informaram ao cirurgião o uso destas drogas. CONCLUSÕES: Na população estudada é elevada a porcentagem do uso de drogas que interferem na coagulação sanguínea, sendo as mais utilizadas o AAS, a vitamina E e o Ginkgo biloba. A maioria dos pacientes pesquisados não informou ao cirurgião a sua utilização. Deve-se enfatizar a necessidade de pesquisar o uso dessas drogas no pré-operatório, com o objetivo de reduzir possíveis complicações hemorrágicas per e pós-operatórias, pelas suas complicações médicas e eventuais implicações legais.
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Otley CC. Perioperative evaluation and management in dermatologic surgery. J Am Acad Dermatol 2006; 54:119-27. [PMID: 16384766 DOI: 10.1016/j.jaad.2005.09.047] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Revised: 09/13/2005] [Accepted: 09/16/2005] [Indexed: 11/27/2022]
Abstract
Thorough and efficient perioperative evaluation is mandatory for all patients undergoing dermatologic operation. Patients may present with concise or extensive medical histories, and an organized approach will focus attention on issues relevant to the patient's dermatologic disease and the planned surgical procedure. Management of common perioperative issues in a proactive and standardized manner, with opportunity to individualize decisions when clinical conditions indicate, is an efficient and optimal approach. This review highlights the efficient and thorough evaluation of perioperative issues and suggests guidelines for the optimal management of common perioperative issues, including cardiac devices, antibiotic prophylaxis, and anticoagulation.
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Affiliation(s)
- Clark C Otley
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Amici JM, Rogues AM, Lasheras A, Gachie JP, Guillot P, Beylot C, Thomas L, Taïeb A. A prospective study of the incidence of complications associated with dermatological surgery. Br J Dermatol 2005; 153:967-71. [PMID: 16225607 DOI: 10.1111/j.1365-2133.2005.06861.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatological surgery is a relatively new and expanding subspecialty within dermatology. Little information is available about complications in this kind of surgery in the European setting. OBJECTIVES The aim of this study was to assess the incidence of anaesthetic, haemorrhagic and infectious complications in dermatological surgery and to highlight the factors associated with these complications. METHODS Data were collected prospectively over a 3-month period for all surgical procedures performed by a network of dermatologists (n = 84 dermatologists) in France, including the excision of all benign or malignant tumours but excluding sebaceous cysts and pyodermas. Information was collected regarding dermatologists, patients, procedures and complications. RESULTS A total of 3788 surgical procedures were available for review; 236 complications, mostly minor, occurred in a total of 213 surgical procedures (6%), bleeding being the most common (3%). Vaso-vagal syncope was the main anaesthetic complication (51 of 54). Infectious complications occurred in 79 patients (2%). Superficial suppuration accounted for 92% of surgical site infections. Only one patient had a systemic infection. Complications requiring additional antibiotic treatment or repeat surgery accounted for only 22 cases of 3788 (1%). No statistically significant correlation was found with the characteristics of the dermatologists, especially with respect to their training or amount of surgical experience. Similarly, no link could be established between complications and surgical conditions. Multivariate analysis showed that anaesthetic or haemorrhagic complications were independent factors for infectious complications. Sex, administration of an anticoagulant or immunosuppressant, type of procedure performed and duration exceeding 24 min were independent factors for haemorrhagic complications. CONCLUSIONS This study shows a low rate of complications associated with dermatological surgery performed by dermatologists under local anaesthesia on an outpatient basis.
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Affiliation(s)
- J M Amici
- Service de Dermatologie, Groupe Hospitalier Saint-André, 1 Rue Jean Burguet, 33075 Bordeaux Cedex, France.
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Abstract
A large number of patients undergoing elective surgical procedures already take routine medication preoperatively. The majority of these patients use drugs for therapy of preexisting cardiovascular, pulmonary or endocrinological diseases which are independent of the planned surgical procedure. The number and type of preoperative drug therapy are correlated to age, gender and co-morbidity of the patients. Furthermore, patients with higher ASA-classes usually take more drugs, as they suffer from several medical diseases. Information about the perioperative handling of routine drug therapy is important for the planning of anaesthesia and surgery. A close cooperation of all medical specialities involved is necessary, in particular when patients take anticoagulants or other substances which should be withdrawn or replaced. This review focuses on the handling of routine preoperative medication by the anaesthesiologist in the light of available literature.
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Affiliation(s)
- K Buhre
- Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany
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Madan GA, Madan SG, Madan G, Madan AD. Minor Oral Surgery Without Stopping Daily Low-Dose Aspirin Therapy: A Study of 51 Patients. J Oral Maxillofac Surg 2005; 63:1262-5. [PMID: 16122588 DOI: 10.1016/j.joms.2005.05.164] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The risk of excessive bleeding prompts physicians to stop low-dose long-term aspirin regimens before surgery, which puts the patient at risk from adverse thrombotic events. We hypothesize that most minor oral surgical procedures can be carried out safely without stopping low-dose aspirin. PATIENTS AND METHODS All minor oral surgery patients at our hospital (Madan Dental Hospital, Ahmedabad, India) from May 2002 to May 2003, who were also on long-term low-dose aspirin therapy regimens (acetylsalicylic acid 75 mg to 100 mg/day), were included. Investigation of bleeding time and platelet count was performed. If within normal limits, aspirin was not stopped before surgery. Patients were operated under local anesthesia on an outpatient basis. All wounds were sutured and followed up at 24, 48, and 72 hours, 1 week, and 2 weeks after the procedure. RESULTS The study included 51 patients (32 males, 19 females), ranging in age from 45 to 70 years. Preoperative values were within normal limits for all patients. Aspirin was not stopped for a single patient. There was no excessive intraoperative bleeding in all cases except 1; there was no postoperative bleeding in all cases. CONCLUSION We conclude that most minor oral surgery procedures can be carried out safely without stopping long-term low-dose aspirin regimen.
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Braganza A, Bissada N, Hatch C, Ficara A. The effect of non-steroidal anti-inflammatory drugs on bleeding during periodontal surgery. J Periodontol 2005; 76:1154-60. [PMID: 16018759 DOI: 10.1902/jop.2005.76.7.1154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND With the increasing prevalence of individuals taking non-steroidal anti-inflammatory drugs (NSAIDs), there is concern as to whether low-dose NSAIDs cause bleeding problems during periodontal surgery. METHODS A controlled, single-blind study was designed to measure the effect of ibuprofen at peak plasma levels on intraoperative bleeding. Fifteen medically healthy subjects (seven males and eight females), each having two sites requiring periodontal surgery of similar complexity, type, and duration, were selected for the study. The subjects were instructed to take ibuprofen prior to one of the surgeries. A standard bleeding time and papillary bleeding index score were recorded at initial consultation, and prior to the first and second surgeries. The volume of aspirated blood was measured during each surgery by subtracting the amount of water used for irrigation from the total volume of fluid (blood + irrigation water) collected at 15-minute intervals during the surgery. RESULTS An analysis of the results showed an increase in intraoperative bleeding when ibuprofen was taken prior to surgery (31.93 +/- 15.72 versus 17.80 +/- 9.57 ml; P <0.01). Ibuprofen appeared to have its greatest effect on bleeding mid-surgery. The average bleeding time also increased significantly (P <0.01) when ibuprofen was preadministered (4.17 +/- 0.96 versus 3.8 +/- 0.92 minutes), although the bleeding remained within the normal range. Papillary bleeding did not show a significant difference between the two surgeries. Surgeries involving osseous resection showed a significant increase in bleeding when ibuprofen was preadministered. CONCLUSION Taken prior to periodontal surgery, ibuprofen increases intraoperative blood loss in patients up to almost two times that of those who did not take ibuprofen.
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Affiliation(s)
- Annabel Braganza
- Department of Periodontics, School of Dental Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4905, USA
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Low-dose aspirin for secondary cardiovascular prevention - cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation - review and meta-analysis. J Intern Med 2005; 257:399-414. [PMID: 15836656 DOI: 10.1111/j.1365-2796.2005.01477.x] [Citation(s) in RCA: 533] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Low-dose aspirin given for secondary prevention of cardiovascular disease is frequently withdrawn prior to surgical or diagnostic procedures to reduce bleeding complications. This may expose patients to increased cardiovascular morbidity and mortality. Aim of the study was to review and quantify cardiovascular risks because of periprocedural aspirin withdrawal and bleeding risks with the continuation of aspirin. METHODS We screened MEDLINE (January 1970-October 2004) with additional manual cross-referencing for clinical studies, surveys on the opinions of doctors and guidelines. RESULTS Studies reporting the relative risk of acute cardiovascular events after aspirin withdrawal when compared with its continuation were not found. However, retrospective investigations revealed that aspirin withdrawal precedes up to 10.2% of acute cardiovascular syndromes. The time interval between discontinuation and acute cerebral events was 14.3 +/- 11.3 days, 8.5 +/- 3.6 days for acute coronary syndromes, and 25.8 +/- 18.1 days for acute peripheral arterial syndromes (P < 0.02 versus acute coronary syndromes). On aspirin-related bleeding risks, we obtained 41 (12 observational retrospective, 19 observational prospective, 10 randomized) studies, reporting on 49 590 patients (14 981 on aspirin). Baseline frequency of bleeding complications varied between 0 (skin lesion excision, cataract surgery) and 75% (transrectal prostate biopsy). Whilst aspirin increased the rate of bleeding complications by factor 1.5 (median, interquartile range: 1.0-2.5), it did not lead to a higher level of the severity of bleeding complications (exception: intracranial surgery, and possibly transurethral prostatectomy). Surveys amongst doctors on the management of this problem demonstrate wide variations. Available guidelines are scarce and in part contradictory. CONCLUSIONS Only if low-dose aspirin may cause bleeding risks with increased mortality or sequels comparable with the observed cardiovascular risks after aspirin withdrawal, it should be discontinued prior to an intended operation or procedure. Controlled clinical studies are urgently needed.
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Abstract
The plastic surgeon is encountering an unprecedented population of aging individuals who both desire cosmetic or reconstructive surgery and may require the use of medications that alter hemostasis. The increasing use of anticoagulants and platelet inhibitors in particular can create challenges for the plastic surgeon. The purpose of this review is to familiarize the surgeon with the medications that can affect hemostasis and to suggest strategies for their use in the perioperative period. Specific case examples are presented.
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Affiliation(s)
- Alan Muskett
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi, Jackson, MS 39216-4505, USA.
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The perioperative management of patients on antiplatelet agents and anticoagulants presenting for plastic surgical operations: a survey of current practice in the UK. EUROPEAN JOURNAL OF PLASTIC SURGERY 2005. [DOI: 10.1007/s00238-005-0721-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Iwamoto T, Kin K, Miyazaki K, Shin K, Takasaki M. Recovery of platelet function after withdrawal of cilostazol administered orally for a long period. J Atheroscler Thromb 2004; 10:348-54. [PMID: 15037824 DOI: 10.5551/jat.10.348] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To clarify the recovery of platelet function after abrupt withdrawal of cilostazol, we studied platelet function and cilostazol concentration in elderly who received cilostazol, 100 mg twice a day (200 mg/day), for a long period. After interviewing the time of final cilostazol intake, platelet aggregability was determined with an aggregometer using four different concentrations of adenosine-5'-diphosphate as an inducer, which showed the grading curve (GC) type and platetet aggregatory threshold index (PATI). Serum cilostazol concentration was also determined by high-performance liquid chromatography. The GC type and PATI showed suppressed platelet function until 15 hours after withdrawal in half of patients. Bleeding time measured by the Simplate method was prolonged within 4 hours, but recovered by 12 hours after the withdrawal. Some serum cilostazol concentrations were still high 15 hours after withdrawal, while platelets were inhibited even in patients with low serum concentration of cilostazol. In the group receiving the drug for less than 6 months, PATI correlated with serum cilostazol concentration, but platelets in the long-term administration group (more than 48 months) were suppressed at the low serum cilostazol concentration. These findings indicated that platelet function recovered within 12-16 hours after withdrawal in these patients.
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Affiliation(s)
- Toshihiko Iwamoto
- Department of Geriatric Medicine, Tokyo Medical University Hospital, Tokyo, Japan.
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