Cutaneous Surgery in Patients Receiving Warfarin Therapy

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Abstract
Background. Anticoagulant treatment with warfarin is an essential therapy in patients with prosthetic heart valves and atrial fibrillation to prevent thromboemoblisms. The question whether to stop warfarin treatment in patients undergoing cutaneous surgery is debatable. Objective. To evaluate the outcome of surgery in patients that were treated with warfarin and underwent excisional and Mohs surgeries. Methods. Warfarin therapy was continued in all patients that underwent excisional and Mohs surgery in our practice from November 1999 to November 2000. Perioperative complications such as bleeding and cosmetic outcome are evaluated. Results. A total of 560 patients underwent Mohs surgery and 530 patients underwent excisional surgery. Sixteen patients (1.5%) were treated with coumadin with international normalized ratio (INR) values within the therapeutic values. Seventy-seven patients that underwent surgery on the same days as the warfarin-treated patients served as the control group. Intraoperative bleeding was easily controlled and postoperative bleeding was not recorded in any of the patients. All wounds healed without any complication, including full-thickness grafts. Conclusion. Coumadin treatment should be continued in patients undergoing cutaneous surgery. This will decrease the risk of thromboembolic events.