Pausing antiplatelet and anticoagulant therapy not required before dermatosurgery for bleeding prevention

Germany: Antiplatelet and anticoagulant (AP/AC) therapy is associated with a higher rate of postoperative bleeding but no life-threatening bleeding was recorded, according to a new prospective study published in the Journal of the European Academy of Dermatology and Venereology: JEADV. 

The researchers revealed that long preoperative pausing or bridging of DOAC (direct oral anticoagulants) does not lead to significantly less severe bleeding events.

Perioperative management of antiplatelet and anticoagulant therapy is a delicate balance between preventing thromboembolic events and minimizing bleeding risks. However, limited data exist for dermatosurgery patients, particularly those on direct oral anticoagulants. The study sought to evaluate the impact of AP/AC medication on bleeding risk in dermatosurgery, with a particular focus on the timing of DOAC intake in relation to the procedure.

The study, conducted by a team of researchers led by Rabea Hoper, examined 1852 dermatosurgery procedures in 675 patients, both with and without AP/AC therapy. All relevant information, including exact times of DOAC intake, the surgical procedure performed, and post-operative bleeding incidents, were meticulously documented by a standardised approach.

● The results revealed that postoperative bleeding occurred in 15.93% of all procedures, though only a small proportion of cases (1.57%) were classified as severe.

● Patients under dual antiplatelet therapy faced a significantly higher incidence of severe postoperative bleeding, accounting for 11.76% of cases.

● Patients who underwent bridging for vitamin K antagonist or DOAC treatment experienced higher rates of severe postoperative bleeding at 9.09% and 15.38%, respectively.

● Despite the increased risk of bleeding associated with AP/AC therapy, the study reported no life-threatening bleeding events among the patients.

● The preoperative DOAC-free period did not significantly impact the frequency of severe bleeding events.

The findings of this study provide valuable insights for physicians managing patients on AP/AC therapy undergoing dermatosurgery. While AP/AC-therapy is linked to a higher risk of postoperative bleeding, the study assures that such incidents are manageable and do not result in life-threatening complications.

As dermatosurgery becomes increasingly common, especially in ageing populations, understanding the influence of AP/AC-therapy on bleeding risk is of paramount importance. The findings pave the way for further research and the development of guidelines tailored to dermatosurgery patients on AP/AC therapy, providing clinicians with evidence-based tools to optimize patient outcomes and safety.

With this new knowledge, dermatologists and surgeons can make well-informed decisions when managing patients on AP/AC therapy, ensuring both effective prevention of thromboembolic events and the safe conduct of dermatosurgery procedures. The study contributes to advancing patient care and enhancing the success of dermatosurgery in a Journal of the European

Academy of Dermatology and Venereology: JEADVdiverse range of individuals with varying medical backgrounds.

Reference:

Höper, R., Rosen, M., Kofler, K., Häfner, H.-M., & Kofler, L. (2023). Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery-A prospective observational study. Journal of the European Academy of Dermatology and Venereology: JEADV. https://doi.org/10.1111/jdv.19228