Does Aspirin Increase Risk of Bleeding in Patients Undergoing Skin Lesion Excision: A Systematic Review and Meta-Analysis

Background: Aspirin is a commonly prescribed medication, which impairs the action of platelets. This also results in a higher risk of bleeding. Cutaneous lesion excision is frequently performed for diagnosis and treatment of malignancies, as well as for aesthetic or functional benefits. We must balance the risk of bleeding against the risk of discontinuing aspirin. We conducted a systematic review, and meta-analysis, in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to evaluate the evidence of postoperative bleeding risk conferred by continuation of aspirin in cutaneous surgery. Methods: A systematic search of the literature was performed. Included studies evaluated the incidence of hemorrhage or hematoma in adults undergoing cutaneous surgery. The following participant characteristics were noted: age, sex, surgical site, and type of wound closure performed. A random-effects model was chosen to calculate the effect size-expressed as odds ratio (OR) with a 95% confidence interval-for bleeding of any severity, moderate severity, severe severity, infection, and wound dehiscence (outcomes). Results: A total of 26,860 procedures were included from 20 studies. A statistically significant increase in odds of bleeding of any severity (16,748 procedures included) OR 1.39 (1.02-1.90) and for bleeding of severe severity (12,311 procedures included) OR 2.46 (1.53-3.95) was identified. Moderate severity bleeding (1629 procedures included) OR 0.92 (0.46-1.81), infection OR 0.60 (0.28-1.28), and wound dehiscence OR 0.92 (0.41-2.06) effect size results did not attain statistical significance. Conclusions: Our analysis identified a statistically significant increase in postoperative bleeding risk for patients taking aspirin and undergoing cutaneous surgery.