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Thrombotic complications with interruption of direct oral anticoagulants in dermatologic surgery
Journal of the American Academy of Dermatology ( IF 13.8 ) Pub Date : 2020-10-09 , DOI: 10.1016/j.jaad.2020.10.008
Spyros M Siscos 1 , Brett C Neill 1 , Anjali Hocker Singh 2 , Thomas L H Hocker 3
Affiliation  

Background

Direct oral anticoagulants (DOACs), such as apixaban, rivaroxaban, and dabigatran, are increasingly being used to provide prophylaxis and treatment for arterial and venous thromboembolism. Multiple procedural subspecialties have implemented guidelines detailing time frames for perioperative DOAC interruption; however, the impact of perioperative DOAC interruption in patients undergoing dermatologic surgery is currently unknown, and evidence-based guidelines are lacking.

Objective

To assess the 30-day postoperative rate of thrombotic complications (ischemic stroke, transient ischemic attack, systemic embolism, deep vein thrombosis [DVT] and pulmonary embolism) in patients with nonvalvular atrial fibrillation (AF) or a history of DVT who underwent perioperative DOAC interruption during dermatologic surgery.

Methods

A retrospective medical record review was performed of all patients with AF or a history of DVT who underwent perioperative DOAC interruption during dermatologic surgery at Advanced Dermatologic Surgery and the University of Kansas Medical Center between January 1, 2016, and August 31, 2020.

Results

Among 806 operations, comprising 750 Mohs micrographic operations (93.1%) and 56 excisions (6.9%), 1 patient (0.14% of patients with AF) sustained a transient ischemic attack and 2 patients (0.25% of all patients) sustained minor bleeding complications during the 30-day postoperative period.

Conclusion

Perioperative DOAC interruption appears to be safe and efficacious in dermatologic surgery.



中文翻译:

皮肤科手术中中断直接口服抗凝剂的血栓并发症

背景

直接口服抗凝剂 (DOAC),例如阿哌沙班、利伐沙班和达比加群,越来越多地用于预防和治疗动静脉血栓栓塞。多个程序亚专业已经实施了详细说明围手术期 DOAC 中断时间范围的指南;然而,目前尚不清楚围手术期 DOAC 中断对接受皮肤科手术的患者的影响,并且缺乏循证指南。

客观的

评估接受围手术期 DOAC 的非瓣膜性房颤 (AF) 或有 DVT 病史的患者术后 30 天血栓并发症(缺血性卒中、短暂性脑缺血发作、全身性栓塞、深静脉血栓形成 [DVT] 和肺栓塞)的发生率在皮肤科手术期间中断。

方法

对 2016 年 1 月 1 日至 2020 年 8 月 31 日期间在 Advanced Dermatologic Surgery 和堪萨斯大学医学中心的皮肤科手术期间接受围手术期 DOAC 中断的所有 AF 或 DVT 病史患者进行回顾性病历审查。

结果

在 806 次手术中,包括 750 次莫氏显微手术 (93.1%) 和 56 次切除 (6.9%),1 名患者(AF 患者的 0.14%)持续短暂性脑缺血发作,2 名患者(所有患者的 0.25%)出现轻微出血并发症在术后 30 天期间。

结论

在皮肤科手术中,围手术期 DOAC 中断似乎是安全有效的。

更新日期:2020-10-09
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