Butt Eman, Hunt William, Defty Clare, Hussain Walayat, Bray Adam, Wernham Aaron
University Hospitals Birmingham NHS Trust, UK.
University Hospitals Plymouth NHS Trust, UK.
Clin Exp Dermatol. 2024 Jan 25;49(2):143-145. doi: 10.1093/ced/llad312.
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.
14%至22%接受皮肤手术的患者会服用抗血栓药物，现在服用直接口服抗凝剂（DOACs）的患者更多。最新证据表明，在皮肤手术中，围手术期停用DOACs的风险较低，尤其是对于一期缝合，但对于更复杂的手术，风险仍不明确。2016年英国皮肤科外科学会（BSDS）指南建议，临床医生可根据个体出血风险，考虑让患者停用DOACs 24至48小时。我们对BSDS成员进行了调查，以更好地了解临床实践和对指南的遵循情况，以期更新该指南。结果表明，临床医生在管理使用阿司匹林、氯吡格雷和华法林等更成熟抗血栓药物的患者方面具有一致性。然而，与术后使用其他抗血栓药物相比，DOACs用于较高风险手术（如较大皮瓣或移植）后，出现明显血肿的感知风险更高。经过个体风险评估并与患者进行充分讨论后，对于较高风险手术，可谨慎考虑在围手术期停用DOACs 24至48小时。
