A national clinician survey on the practice and views of the British Society for Dermatological Surgery (BSDS) guidelines on antithrombotic agent use in skin surgery

Abstract

14-22.3% of patients undergoing skin surgery take an anti-thrombotic medication, with more patients now taking Direct Oral Anticoagulants (DOACs). Latest evidence suggests the risk of stopping DOACs peri-operatively is low in skin surgery, particularly for primary closures, but remains unclear for more complex procedures. The 2016 British Society for Dermatological Surgery (BSDS) guidance suggested consideration of stopping DOACS for 24-48 hours based on individual bleeding risk. We developed an online survey of BSDS members to better understand clinical practice and guideline adherence with a view to updating the guidance. Results demonstrated that there is consistency amongst clinicians in management of patients on more established antithrombotic agents, such as aspirin, clopidogrel and warfarin. However, there is a higher perceived risk of significant haematomas following higher risk procedures such as larger flaps or grafts with DOACs versus other antithrombotic post-operatively. Stopping DOACs peri-operatively for 24-48 hours for higher risk procedures can be cautiously considered following an individual risk assessment and informed discussion with the patient.