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S3 guidelines for the management of anticoagulation in cutaneous surgery
Author(s) -
Sporbeck Birte,
Bechara Falk Georges,
Häfner HansMartin,
Koenen Wolfgang,
Kolk Andreas,
Koscielny Jürgen,
Meissner Markus,
Pokrywka Anna,
Schirmer Steffen,
Strömer Klaus,
Löser Christoph,
Nast Alexander
Publication year - 2015
Publication title -
jddg: journal der deutschen dermatologischen gesellschaft
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 60
eISSN - 1610-0387
pISSN - 1610-0379
DOI - 10.1111/ddg.12576
Subject(s) - medicine , guideline , perioperative , vitamin k , surgery , medline , intensive care medicine , general surgery , pathology , political science , law
Summary Background An increasing number of patients are being treated with anticoagulants and platelet inhibitors. Whenever surgical procedures of the skin are required, questions arise regarding the perioperative management of anticoagulation. Methods Development of S3 guidelines following the requirements of the Association of Scientific Medical Societies, systematic literature search and analysis, use of GRADE methodology, structured consensus conference using a nominal group process. Results During cutaneous surgery, treatment with acetylsalicylic acid (ASA) should be continued if medically necessary. In procedures with a higher risk of bleeding and a positive bleeding history, INR should be determined preoperatively. Surgical procedures of the skin with a higher risk of bleeding should not be performed if the INR is above therapeutic range. Bridging from vitamin K antagonists (VKA) to heparin should not be performed just because of the surgery of the skin. As to direct‐acting oral anticoagulants, the last dose should be taken 24 h preoperatively. Conclusions The recommendations issued by the German guidelines group are mostly in line with recommendations provided by other guidelines. The American ìChest‐Guidelineì recommends continuing VKAs and acetylsalicylic acid during minor dermatologic procedures. In their guidelines, the German College of General Practitioners and Family Physicians considers an INR of 2 to be adequate in surgical procedures on the skin.