Constantinescu Monica, Penela Olivia, Bhate Chinmoy, Cognetta Armand
Dermatology, Dermatology Associates of Tallahassee, Tallahassee, USA.
Medicine, Mercer University School of Medicine, Columbus, USA.
Cureus. 2025 May 3;17(5):e83408. doi: 10.7759/cureus.83408. eCollection 2025 May.
Direct factor Xa inhibitors or direct oral anticoagulants, like apixaban, are used to reduce the risk of stroke, deep vein thrombosis, and pulmonary embolism. It is essential that patients prescribed these drugs follow the instructions carefully. When a patient needs surgery and is on a direct oral anticoagulant, the question arises as to whether they should stop taking it before the elective surgery. There are currently no well-established guidelines instructing whether a patient should discontinue taking them before a Mohs procedure. A Mohs procedure is a precise surgery that removes skin cancers. We describe two cases of delayed-onset hematoma formation following Mohs micrographic surgery and reconstruction in patients taking direct oral anticoagulants not withheld prior to the procedure. Due to the possible uniqueness of late-onset hematoma formation greater than two weeks post-operatively in patients taking apixaban, we wanted to bring this event to the attention of other physicians. This report highlights the need to instruct patients on the possible complications of continuing the prescription and the importance of consulting the prescribing doctor before telling the patient to cease taking the drugs.
直接凝血因子Xa抑制剂或直接口服抗凝药，如阿哌沙班，用于降低中风、深静脉血栓形成和肺栓塞的风险。至关重要的是，服用这些药物的患者要严格遵循医嘱。当患者需要手术且正在服用直接口服抗凝药时，就会出现是否应在择期手术前停药的问题。目前尚无完善的指南指导患者在莫氏手术前是否应停用此类药物。莫氏手术是一种切除皮肤癌的精确手术。我们描述了两例在接受莫氏显微外科手术和重建术后出现迟发性血肿形成的病例，这两名患者在手术前未停用直接口服抗凝药。鉴于服用阿哌沙班的患者术后两周以上出现迟发性血肿形成可能具有独特性，我们希望引起其他医生对此事件的关注。本报告强调了告知患者继续用药可能出现的并发症的必要性，以及在告知患者停药前咨询开处方医生的重要性。
