Why the study?
Does discontinuing warfarin prior to cutaneous surgery increase the risk of thromboembolic stroke compared to continuing it?
Does discontinuing warfarin prior to cutaneous surgery increase the risk of thromboembolic stroke compared to continuing it?
Warfarin should not be discontinued prior to cutaneous surgery due to the high risk of thromboembolic stroke and the low, manageable risk of bleeding.
Supports continuing warfarin in cutaneous surgery to minimize stroke risk; leaves open confirmation by randomized trials.
BACKGROUND: Two patients undergoing cutaneous surgery had thromboembolic strokes within 1 week after surgery. Both patients had been taking warfarin for prevention of thromboembolism and warfarin was stopped 3-7 days prior to surgery. OBJECTIVE: To examine the rationale and problems associated with preoperative warfarin discontinuation. METHODS: Review of the medical literature. RESULTS: When warfarin is stopped prior to surgery and restarted soon after surgery, the patient is at increased risk for thromboembolism. Although it is commonly believed that continuing warfarin during surgery is associated with an increased bleeding risk, for cutaneous surgery, this risk is extremely low and can be easily managed. CONCLUSION: Warfarin should not be discontinued prior to cutaneous surgery because of the risk of thromboembolic stroke.
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Schanbacher et al. (2000) studied this question.
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