Perioperative management of novel oral anticoagulants in skin surgery: a national survey

A recent study has shown that as many as 38% of patients who undergo skin surgery are on an antiplatelet or anticoagulant agent. ¹ With the recent publication of the National Institute for Health and Care Excellence (NICE) guidelines on the use of novel oral anticoagulants (NOACs) for atrial fibrillation², deep vein thrombosis and pulmonary embolism^3-5, we are likely to see an increasing number of patients on these agents (i.e. dabigatran, rivaroxaban and apixaban) undergoing skin surgery. NICE has recently recommended that small skin excisions (procedures that have ‘no clinically important bleeding risk’) can be performed just before the next dose is due, or approximately 18-24 hours after the last dose (i.e. one dose may be missed).⁶ However, there is no recommendation on more complex dermatological procedures (i.e. Mohs surgery, flaps and/or grafts).

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