Division of Evidence-Based Medicine, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
J Dtsch Dermatol Ges. 2022 Jul;20(7):941-950. doi: 10.1111/ddg.14758. Epub 2022 Jun 24.
We identified substantial heterogeneity in the perioperative management of antithrombotic drugs in skin surgery in Germany in 2012 and 2017 in two cross-sectional surveys. The first national guideline on this subject was published in 2014 and updated in 2021. We sought to identify whether the management of these drugs had changed.
We sent a paper-based survey to 1115 dermatologists throughout Germany asking them about their perioperative management of antithrombotic drugs in skin surgery, as well as their familiarity with the guideline.
We received responses from 65 hospital- and 202 office-based dermatologists. Most dermatologists reported continuing antithrombotic drugs in their patients when performing minor surgeries. A notable proportion of dermatologists reported discontinuing phenprocoumon treatment perioperatively and bridging patients with heparin when performing more invasive surgeries. Continuation was less common during combination therapies.
The proportion of physicians in Germany who reported managing antithrombotic drugs during skin surgery in ways that are in concordance with the national guideline has increased since 2012. However, continuing antithrombotic drugs during large excisions and sentinel lymph node biopsies, abstaining from bridging patients on phenprocoumon with heparin, and continuing antithrombotic combination therapies perioperatively need to be further encouraged, especially among office-based dermatologists.
我们在 2012 年和 2017 年的两项横断面调查中发现，德国皮肤外科围手术期抗血栓药物管理存在很大的异质性。2014 年发表了第一份关于该主题的国家指南，并于 2021 年进行了更新。我们试图确定这些药物的管理是否发生了变化。
我们向德国各地的 1115 名皮肤科医生发送了一份纸质调查问卷，询问他们在皮肤外科围手术期抗血栓药物的管理情况，以及他们对指南的熟悉程度。
我们收到了来自 65 家医院和 202 家诊所的皮肤科医生的回复。大多数皮肤科医生报告在进行小手术时继续为患者使用抗血栓药物。相当一部分皮肤科医生报告在进行更具侵入性手术时停止使用苯丙香豆素治疗并桥接肝素治疗患者。联合治疗时，继续治疗的情况较少。
自 2012 年以来，德国报告在皮肤外科手术中按照国家指南管理抗血栓药物的医生比例有所增加。然而，在大切除和前哨淋巴结活检期间继续使用抗血栓药物、避免在苯丙香豆素治疗期间桥接肝素治疗患者以及在围手术期继续使用抗血栓联合治疗仍需进一步鼓励，尤其是在诊所的皮肤科医生中。
