A review of traditional and novel oral anticoagulant and antiplatelet therapy for dermatologists and dermatologic surgeons

Background: Dermatologic surgeons will increasingly encounter patients on novel oral antiplatelet and anticoagulant medications. Objectives: We conducted a complete overview of the pharmacokinetics, pharmacodynamics, and side effects of traditional and novel oral anticoagulant and antiplatelet therapies along with dietary supplements with anticoagulant or antiplatelet properties. Methods: A PubMed search was completed for "aspirin,'' "warfarin,'' "clopidogrel,'' "dabigatran,'' "rivaroxaban,'' "apixaban,'' "prasugrel,'' and "ticagrelor.'' Review articles and publications emphasizing perioperative management of oral anticoagulant or antiplatelet medications were selected. An additional PubMed search was completed for "hemorrhage,'' "bleeding,'' and "thrombosis'' in conjunction with "dermatology,'' "dermatologic surgery,'' and "cutaneous surgery.'' Results: Aspirin, clopidogrel, and warfarin have shortfalls in dosing, monitoring, and efficacy. Several trials show superior efficacy with dabigatran, rivaroxaban, and apixaban, with equal or reduced risk of bleeding compared with warfarin. Prasugrel and ticagrelor may be associated with an increased bleeding risk. Many over-the-counter medications also have anticoagulant properties with associated bleeding risks that cannot be overlooked. Limitations: There are few publications evaluating the novel oral anticoagulants' effects on outpatient surgical procedures. Conclusion: Novel anticoagulant and antiplatelet drugs are revolutionizing therapy for cardiovascular diseases. As these medications become more prevalent, dermatologists and dermatologic surgeons must be mindful of the bleeding risk that will apply in our everyday practices.