Studies show that holding single antithrombotic agents perioperatively increases the risk of acute thrombotic events and does not significantly decrease the risk of bleeding complications in dermatological surgery.
In patients who are undergoing minor dermatologic procedures and are receiving VKAs, we recommend continuing VKAs around the time of the procedure (Grade 1C ACCP recommendation).
In patients who are undergoing minor dermatologic procedures and are receiving aspirin, we recommend continuing aspirin around the time of the procedure (Grade 1C ACCP recommendation). Aspirin can be stopped for 7 days prior to procedure if Aspirin is given for CAD prevention only.
In patients who are undergoing minor dermatologic procedures and are receiving clopidogrel, recommendation is to continue medication. If patients are concerned about risk of excessive bleeding, and have been on antiplatelet therapy for > 1 year, patient is asked to contact his/her Cardiologist.
Minor dermatological procedures are associated with little blood loss.
Major bleeding is rare with continuation of therapeutic anticoagulation. Bleeding risks increase when aspirin and NSAID’s are given in addition to VKAs.
Patients should be given instructions to deal with potential bleeding, and should be advised about when to seek medical attention for excessive bleeding.
General Recommendations for Pre-Procedure Warfarin Management
- Maintain INR as close to 2.0 as possible while avoiding adverse events.
- For MOHS surgery, maintain INR ≤3.0 within 10 days of the procedure.