SLR - October 2015 - Sarah Breakstone

Anticoagulant Complications in Facial Plastic and Reconstructive Surgery

Reference: Kraft CT, Bellile E, Baker SR, Kim JC, Moyer JS. Anticoagulant Complications in Facial Plastic and Reconstructive Surgery. JAMA Facial Plast Surg. 2015 Mar-Apr; 17(2): 103-7.

Scientific Literature Review

Reviewed By: Sarah Breakstone, DPM
Residency Program: Mount Sinai Hospital Manhattan

Podiatric Relevance: Knowing which medications to discontinue or continue during the perioperative period is essential for podiatric surgeons. Antiplatelet and anticoagulant therapies are commonly prescribed medications. About 19.3 percent of the US adult population takes aspirin. This case-control study examines a six-year period of patients who were taking anticoagulant and/or anticoagulation during surgery matched with a control population that were not.

Methods: A retrospective analysis of 9204 facial plastic surgical procedures were performed between January 1, 2007 and December 31, 2012 at the University of Michigan Cancer Center and affiliated surgical sites. Of those procedures, 320 patients were identified to have taken antiplatelet and/or anticoagulation medication perioperatively. A control population was chosen from the 9204 during the same time that did not take antiplatelet and/or anticoagulation therapy perioperatively. Aspirin, warfarin, and clopidogrel were the antiplatelet and anticoagulant therapies that were studied. Three hundred and twenty matched pairs were compared using an “optimal” matching algorithm developed by Bergstralh and colleagues from the Mayo Clinic. Complication rates during the preoperative, operative, and postoperative periods were compared and analyzed.

Results: From the 320 patients taking antiplatelet and/or anticoagulation therapy, forty-two patients (13.1 percent) had at least one complication and five patients (1.6 percent) had a severe complication. In contrast to patients who were not taking antiplatelet and/or anticoagulation therapy there were 52 patients (16.2 percent) that experienced at least one complication and five patients (1.6 percent) that had a severe complication. Antiplatelet and/or anticoagulation therapies were then analyzed based on complication rates. There was no increase in complications with patients taking aspirin and clopidogrel. The patients taking warfarin had increased bleeding (OR [95 percent CI], 3.80 [1.15-12.60]) and postoperative infections (OR [95 percent CI], 7.29 [1.17-45.40]).

Conclusions: In a population taking antithrombotic therapy, it was found that patients who took aspirin at the time of surgery did not have more complications than the ones who did not take aspirin. Warfarin and a combination of antiplatelet and/or anticoagulation therapies increased complications and infection rates. This study discussed that discontinuation of antiplatelet and/or anticoagulation is dependent on the type of medication and the extent of the surgery. It may provide surgeons with the confidence to continuing a surgery despite the fact a patient is on an aspirin regiment. 

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