A national clinician survey on the British Society for Dermatological Surgery guidelines on antithrombotic agent use in skin surgery

Author:

Butt Eman1,Hunt William2,Defty Clare3,Hussain Walayat4,Bray Adam5,Wernham Aaron3ORCID

Affiliation:

1. University Hospitals Birmingham NHS Trust , UK

2. University Hospitals Plymouth NHS Trust , UK

3. Walsall Healthcare NHS Trust , Walsall , UK

4. Leeds Teaching Hospitals NHS Trust , Leeds , UK

5. Bristol Royal Infirmary , Bristol , UK

Abstract

Abstract Antithrombotic medication is taken by 14–22% patients undergoing skin surgery, with more patients now taking direct oral anticoagulants (DOACs). The latest evidence suggests that the risk of stopping DOACs perioperatively is low in skin surgery, particularly for primary closures, but remains unclear for more complex procedures. The 2016 British Society for Dermatological Surgery (BSDS) guidelines suggest that clinicians could consider stopping DOACs in patients for 24–48 h, based on individual bleeding risk. We surveyed BSDS members to better understand clinical practice and guideline adherence with a view to updating the guidance. The results demonstrated that there is consistency among clinicians in the management of patients on more established antithrombotic agents, such as aspirin, clopidogrel and warfarin. However, there is a higher perceived risk of significant haematomas following higher-risk procedures such as larger flaps or grafts with DOACs vs. other antithrombotics postoperatively. Stopping DOACs perioperatively for 24–48 h for higher-risk procedures can be cautiously considered following an individual risk assessment and informed discussion with the patient.

Publisher

Oxford University Press (OUP)

Subject

Dermatology

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