Anticoagulation and Cutaneous Surgery Otley CC: Continuation of medically necessary aspirin and warfarin during cutaneous surgery. Mayo Clin Proc 2003;78(11):1392-1396.

Decisions to stop anticoagulation therapy in the perioperative period weigh individual risk of life-threatening thrombotic events against potential reduced bleeding risks of surgery. During cutaneous surgery, patients who are not taking warfarin or aspirin have a 1.4% risk of postoperative oozing or hematoma. Since 1994, six small controlled studies have reported no increased risk of hemorrhagic complications during cutaneous surgery in patients who are taking warfarin or aspirin. Although uncommon, thromboembolic complications including death have been reported during the brief perioperative period when anticoagulant drugs have been stopped. Otley advises that patients without deep cutaneous surgery should have warfarin continued through the procedure, with the international normalized ratio within the accepted therapeutic range.

Aspirin that is not medically necessary can be stopped. Medically necessary aspirin, such as for secondary prevention in patients with a history of stroke or atrial fibrillation, should be continued unless the procedure will involve deep tissue resection or dissection. Because primary care providers are involved in anticoagulation decisions for many patients who undergo cutaneous surgery, they need to be familiar with this recent data, which suggests that continuing medically necessary anticoagulant therapy outweighs the risks during superficial cutaneous surgery.