Complications of cutaneous surgery in patients taking clopidogrel-containing anticoagulation.

Autor: Cook-Norris RH; Department of Dermatology, Mayo Clinic, Rochester, Minnesota., Michaels JD; A visiting medical student from the University of Nevada School of Medicine, Reno, Nevada., Weaver AL; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota., Phillips PK; Department of Dermatology, Mayo Clinic, Rochester, Minnesota., Brewer JD; Department of Dermatology, Mayo Clinic, Rochester, Minnesota., Roenigk RK; Department of Dermatology, Mayo Clinic, Rochester, Minnesota., Otley CC; Department of Dermatology, Mayo Clinic, Rochester, Minnesota. Electronic address: otley.clark@mayo.edu.
Jazyk: angličtina
Zdroj: Journal of the American Academy of Dermatology [J Am Acad Dermatol] 2011 Sep; Vol. 65 (3), pp. 584-591. Date of Electronic Publication: 2011 Apr 21.
DOI: 10.1016/j.jaad.2011.02.013
Abstrakt: Background: Most anticoagulants are not associated with increased risk of severe complications during cutaneous surgery, but no data exist on clopidogrel.
Objective: We sought to determine frequency and severity of perioperative complications in patients taking clopidogrel-containing anticoagulation.
Methods: This was a retrospective review of medical records of patients undergoing Mohs micrographic surgery at Mayo Clinic, Rochester, MN, while taking clopidogrel-containing anticoagulation between 2004 and 2008, compared with control subjects taking aspirin monotherapy or no anticoagulants.
Results: In all, 220 patients taking clopidogrel-containing anticoagulation underwent 363 surgical procedures on 268 occasions. Severe complications occurred in 11 of 363 surgical sites in 10 cases. Clopidogrel-containing anticoagulation was 28 times more likely than no anticoagulation and 6 times more likely than aspirin monotherapy to result in severe complications after Mohs procedures (P < .001 and P = .022, respectively). Severe complications were 8 times more likely after Mohs procedures in patients taking both clopidogrel and aspirin than in control subjects taking aspirin monotherapy (P = .009). No statistically significant difference was found between patients taking clopidogrel monotherapy and control subjects not taking anticoagulants (P = .15). Patients experiencing severe complications were more likely to have larger postoperative surgical sites (P < .001). No thrombotic complications were encountered with discontinuation of clopidogrel-containing anticoagulation; a postoperative thrombotic complication occurred in one patient whose clopidogrel-containing anticoagulation regimen was modified.
Limitations: Retrospective nature of study, possible recall bias as a result of telephone contact, and small number of severe complications were limitations, which reduced study power.
Conclusion: Cutaneous surgery in patients taking clopidogrel-containing anticoagulation is associated with an increased risk of nonlife-threatening severe complications.
(Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)
Databáze: MEDLINE
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