Effect of aspirin and nonsteroidal antiinflammatory drug therapy on bleeding complications in dermatologic surgical patients.

BACKGROUND

Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) inhibit platelet cyclooxygenase activity, resulting in altered platelet function and thus potentially enhanced bleeding.

OBJECTIVE

We examined the frequency of operative bleeding complications in dermatologic surgical patients taking these drugs and the value of template bleeding time estimates in predicting this complication.

METHODS

Bleeding time was measured with and without therapy in 23 patients and was correlated to bleeding complications after skin tumor or benign lesion excision in 40 patients taking aspirin, 21 taking NSAIDs, and 20 taking neither drug.

RESULTS

Bleeding time dropped significantly (p < 0.01) when patients stopped therapy for at least 5 days (median, 7 days), although bleeding time was prolonged in only 6 of 16 patients taking aspirin and 2 of 7 taking NSAID. In patients who continued antiplatelet drugs during surgery, bleeding time was prolonged in 8 of 40 patients taking aspirin and in 1 of 21 treated with NSAIDs. Excessive intraoperative bleeding occurred in three aspirin-treated patients, all of whom had a prolonged bleeding time, compared with none of those with normal bleeding times (p < 0.001, Fisher's exact probability test) and with none of those taking NSAIDs. Postoperative ooze requiring a dressing replacement occurred in one NSAID-treated patient and in three patients taking neither drug.

CONCLUSION

Bleeding time is increased by aspirin and NSAID therapy but is prolonged beyond the normal range in only approximately 25% of aspirin-treated and 10% of NSAID-treated patients. Intraoperative bleeding complications occurred only in patients receiving aspirin who had a prolonged bleeding time. Postoperative oozing occurred only in NSAID-treated and in untreated patients and thus is probably unrelated to antiplatelet therapy. Patients with a normal bleeding time can continue aspirin or NSAID therapy before dermatologic surgery.