Anticoagulant or antiplatelet therapy can be continued during the perioperative period in patients having facial plastic surgery without increased risk of serious complications, according to a large observational study.

Dr. Jeffrey S. Moyer, Chief of Facial Plastic and Reconstructive Surgery at the University of Michigan believes the results will lead to a “change in clinical practice for many physicians since discontinuing aspirin or coumadin is fairly standard for many surgeons performing these types of procedures,” he told Reuters Health.

Dr. Moyer and colleagues analyzed complication rates in 320 patients who underwent facial plastic surgical procedures while receiving antiplatelet and/or anticoagulant therapy (aspirin, clopidogrel, or warfarin), compared to a matched control group of 320 patients who did not receive this therapy in the perioperative period.

According to their report online now in JAMA Facial Plastic Surgery, 42 patients (13.1%) who used anticoagulant or antiplatelet medication perioperatively had at least one complication compared with 52 (16.2%) control patients who did not. Five patients in each group had a severe complication (1.6%).

Patients on aspirin at the time of surgery were not more likely than controls to have a complication (odds ratio 0.73). Patients on aspirin and clopidogrel also didn’t have increased complication rates.

“This finding is consistent with most publications, which have found that aspirin can be safely continued during the perioperative period with no significant increase in complications in patients who undergo various cutaneous surgical procedures,” the investigators say.

Patients taking warfarin did have an increased risk for perioperative bleeding and postoperative infections (odds ratios 3.80 and 7.29, respectively). None of the patients who were taking warfarin plus aspirin had complication rates that reached statistical significance owing to small numbers in this group, but there was a “strong trend” toward more complications, the investigators say.

However, they didn’t see any increase in serious complications, such as flap necrosis, dehiscence, or return to the operating room, in patients taking warfarin in the perioperative period.

“The decision as to whether to discontinue antiplatelet or anticoagulant medications involves an assessment of the qualitative or quantitative risk involved with continuation vs discontinuation of these medications,” the investigators acknowledge in their article.
Dr. Moyer told Reuters Health, “The findings that there were no increases in complications with aspirin or serious complications with coumadin (though bleeding and infection rates are higher with coumadin) suggests that continuing these medications could limit the much more serious complications associated with discontinuing aspirin or coumadin (for example, stroke or death).”

“Patients who are taking multiple agents should be weaned to a single agent, if possible, given the likely increased risk of complications in this population,” the investigators add in their article.

SOURCE: http://bit.ly/1rv8C2q

JAMA Facial Plast Surg 2014.