Outcomes of Skin Grafting in Patients Taking Anticoagulants

Kristen Aliano MD, Jessica Korsh MS, and Thomas Davenport MD

Background

Many surgical patients take anticoagulant medications: Clopidogrel Aspirin Warfarin Enoxaparin

These drugs are taken for a variety of serious medical problems: Atrial fibrillation Myocardial infarction Deep vein thrombosis Pulmonary embolism Stroke

Little research has been published regarding the perioperative use of these medications in patients undergoing split-thickness and full-thickness skin grafting There are no current guidelines regarding the perioperative use of these medications in patients undergoing cutaneous procedures

Objective

Aspirin

To investigate the surgical complications in skin graft patients taking medications that inhibit primary or secondary hemostasis

Methods Using ICD-9 codes, we established a cohort of patients who underwent skin grafting by a single plastic surgeon over the course of one year We then reviewed the medication records of each individual in the cohort in order to elucidate which patients were taking aspirin, clopidogrel, warfarin, or enoxaparin. The outcomes of those on anticoagulant medications were then examined

Results

43 patients in the cohort 13 were taking one or more anticoagulant medications: 10 female and 3 make Average Age: 72.6 years 7 patients took warfarin alone 1 patient took warfarin and

enoxaparin 1 patient took clopidogrel and

warfarin 1 patient took clopidogrel alone 3 patients took aspirin alone

Reasons for anticoagulant therapy: Atrial fibrillation CAD PVD Strokes/TIAs Factor V Leiden Congenital heart disease Essential thrombocytosis Rheumatic heart disease

All successfully underwent skin grafting with wound VAC placement 100% graft take No failures No blood transfusions required

Conclusion

Although our sample size is relatively small, we feel that there is no increased risk of bleeding complications in patients taking antithrombotic medications while undergoing skin grafting. The risks of discontinuing the medications prior to surgery may outweigh any potential benefit of minimizing intra- and post-operative bleeding