Hemorrhagic complications of cutaneous surgery for patients taking antithrombotic therapy: a systematic review and meta-analysis

被引:6
|
作者
Bonadurer, George F., III [1 ]
Langeveld, Andrea P. [1 ]
Lalla, Soogan C. [1 ,2 ]
Roenigk, Randall K. [1 ]
Arpey, Christopher J. [1 ]
Otley, Clark C. [1 ]
Baum, Christian L. [1 ]
Trzasko, Leah C. Osterhaus [3 ]
Brewer, Jerry D. [1 ]
机构
[1] Mayo Clin, Dept Dermatol, 200 First St SW, Rochester, MN 55905 USA
[2] NYC Hlth & Hosp, Cent Off Div, 55 Water St, New York, NY 10041 USA
[3] Mayo Clin, Dept Mayo Med Lib Ms Osterhaus Trzasko, Rochester, MN USA
关键词
Cutaneous surgery; Mohs micrographic surgery; Antithrombotic therapy; Postoperative complications; POSTOPERATIVE BLEEDING COMPLICATIONS; INTERNATIONAL NORMALIZED RATIO; SKIN-CANCER SURGERY; ASPIRIN USE; PERIOPERATIVE MANAGEMENT; ORAL ANTICOAGULANTS; RISK; WARFARIN; HEAD; INCREASE;
D O I
10.1007/s00403-021-02250-x
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
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.
引用
收藏
页码:533 / 540
页数:8
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