Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology und Allergy, Division of Evidence--Based Medicine (dEBM).
Skin Cancer Center, Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany.
J Dtsch Dermatol Ges. 2018 Mar;16(3):297-305. doi: 10.1111/ddg.13459.
A survey in 2012 revealed marked heterogeneity in the management of antithrombotic agents in dermatologic surgery in Germany. An evidence-based guideline on this topic was published for the first time in 2014.
Using the same study sample, we conducted an anonymous survey on the management of antithrombotic agents and familiarity with the guideline. We reported the results as relative frequencies and compared them with those from 2012.
We analyzed a total of 208 questionnaires (response rate: 36.6 %). A large majority of dermatologists reported performing minor procedures without discontinuing low-dose aspirin (≤ 100 mg), clopidogrel, or direct oral anticoagulants. In contrast, antithrombotic management was still heterogeneous in the context of major procedures, especially among office-based dermatologists. Overall, there was an increase in the proportion of dermatologists who managed phenprocoumon, aspirin, and clopidogrel in compliance with the guideline. For example, while 53.8 % of hospital-based dermatologists and 36.3 % of office-based dermatologists had performed large excisions on continued low-dose aspirin treatment in 2012, these figures showed an increase to 90.2 % and 57.8 %, respectively, by 2017 (phenprocoumon: from 33.8 % and 11.9 % to 63.9 % and 29.9 %, respectively; clopidogrel: from 36.9 % and 23.2 % to 63.9 % and 30.6 %, respectively). Among hospital dermatologists a large proportion was familiar with the guideline and considered it to be useful.
Our results suggest that compliance with the German guideline on the perioperative management of antithrombotics in dermatologic surgery has increased for all procedures. Despite this positive development, greater efforts are needed to improve implementation of the guideline and address barriers to its use in everyday practice.
2012 年的一项调查显示，德国皮肤科手术中抗血栓药物的管理存在明显的异质性。2014 年首次发布了关于该主题的循证指南。
我们使用相同的研究样本，就抗血栓药物的管理和对指南的熟悉程度进行了匿名调查。我们报告了相对频率的结果，并将其与 2012 年的结果进行了比较。
我们分析了总共 208 份问卷（应答率：36.6%）。绝大多数皮肤科医生报告说，在不停止低剂量阿司匹林（≤100mg）、氯吡格雷或直接口服抗凝剂的情况下进行小手术。相比之下，在大手术中，抗血栓药物的管理仍然存在异质性，尤其是在以诊所为基础的皮肤科医生中。总的来说，遵守指南管理苯丙香豆素、阿司匹林和氯吡格雷的皮肤科医生比例有所增加。例如，虽然 2012 年有 53.8%的医院皮肤科医生和 36.3%的诊所皮肤科医生在继续接受低剂量阿司匹林治疗的情况下进行了大切除，但到 2017 年，这一数字分别增加到 90.2%和 57.8%（苯丙香豆素：分别从 33.8%和 11.9%增加到 63.9%和 29.9%；氯吡格雷：分别从 36.9%和 23.2%增加到 63.9%和 30.6%）。在医院皮肤科医生中，很大一部分人熟悉该指南，并认为它很有用。
我们的结果表明，所有手术的抗血栓药物围手术期管理都符合德国指南。尽管取得了这一积极进展，但仍需要加大努力，以改善指南的实施，并解决在日常实践中使用该指南的障碍。
