Increasingly patients undergoing cutaneous surgery are taking antiplatelet and anticoagulant medications. This article summarises the risks of continuing and withholding these medications for skin surgery. The authors outline practical steps that can be taken to manage these medications prior to skin surgery.
The article considers whether patients should stop taking their blood-thinning medication before surgery, outlining the various different scenarios in answer to that question. The authors stress that 'any decision made with regards to anticoagulant or antiplatelet medications must be made with the patient/or their power of attorney for health', a key principle of informed consent and one upheld by the Montgomery Judgement.
With the Montgomery Judgement in mind, the article advises in detail which questions can help navigate the informed decision-making process with the patient, including:
- Why is the patient taking blood-thinning medication?
- Where is the site of surgery?
- What is the complexity of the procedure?
- Which blood thinner is the patient taking?
- What are the balanced risks of continuing or stopping the medication and how might these be managed?
The authors also outline an interesting case study study of an 80-year-old man with a history of atrial fibrillation, diabetes mellitus and hypertension who takes Apixaban and is due a skin excision of a 3cm diameter squamous cell carcinoma on the scalp with a split thickness skin graft repair.
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