Complications of cutaneous surgery in patients taking clopidogrel- containing anticoagulation

Robert H. Cook-Norris, Jason D. Michaels, Amy L. Weaver, P. Kim Phillips, Jerry D. Brewer, Randall K. Roenigk, Clark C. Otley

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: Most anticoagulants are not associated with increased risk of severe complications during cutaneous surgery, but no data exist on clopidogrel. Objective: We sought to determine frequency and severity of perioperative complications in patients taking clopidogrel-containing anticoagulation. Methods: This was a retrospective review of medical records of patients undergoing Mohs micrographic surgery at Mayo Clinic, Rochester, MN, while taking clopidogrel-containing anticoagulation between 2004 and 2008, compared with control subjects taking aspirin monotherapy or no anticoagulants. Results: In all, 220 patients taking clopidogrel-containing anticoagulation underwent 363 surgical procedures on 268 occasions. Severe complications occurred in 11 of 363 surgical sites in 10 cases. Clopidogrel-containing anticoagulation was 28 times more likely than no anticoagulation and 6 times more likely than aspirin monotherapy to result in severe complications after Mohs procedures (P <.001 and P =.022, respectively). Severe complications were 8 times more likely after Mohs procedures in patients taking both clopidogrel and aspirin than in control subjects taking aspirin monotherapy (P =.009). No statistically significant difference was found between patients taking clopidogrel monotherapy and control subjects not taking anticoagulants (P =.15). Patients experiencing severe complications were more likely to have larger postoperative surgical sites (P <.001). No thrombotic complications were encountered with discontinuation of clopidogrel-containing anticoagulation; a postoperative thrombotic complication occurred in one patient whose clopidogrel-containing anticoagulation regimen was modified. Limitations: Retrospective nature of study, possible recall bias as a result of telephone contact, and small number of severe complications were limitations, which reduced study power. Conclusion: Cutaneous surgery in patients taking clopidogrel-containing anticoagulation is associated with an increased risk of nonlife-threatening severe complications.

Original languageEnglish (US)
Pages (from-to)584-591
Number of pages8
JournalJournal of the American Academy of Dermatology
Volume65
Issue number3
DOIs
StatePublished - Sep 2011

Fingerprint

clopidogrel
Dermatologic Surgical Procedures
Aspirin
Anticoagulants
Mohs Surgery

Keywords

  • anticoagulation
  • aspirin
  • blood thinners
  • clopidogrel
  • cutaneous surgery
  • Mohs micrographic surgery

ASJC Scopus subject areas

  • Dermatology

Cite this

Cook-Norris, R. H., Michaels, J. D., Weaver, A. L., Phillips, P. K., Brewer, J. D., Roenigk, R. K., & Otley, C. C. (2011). Complications of cutaneous surgery in patients taking clopidogrel- containing anticoagulation. Journal of the American Academy of Dermatology, 65(3), 584-591. https://doi.org/10.1016/j.jaad.2011.02.013

Complications of cutaneous surgery in patients taking clopidogrel- containing anticoagulation. / Cook-Norris, Robert H.; Michaels, Jason D.; Weaver, Amy L.; Phillips, P. Kim; Brewer, Jerry D.; Roenigk, Randall K.; Otley, Clark C.

In: Journal of the American Academy of Dermatology, Vol. 65, No. 3, 09.2011, p. 584-591.

Research output: Contribution to journalArticle

Cook-Norris, RH, Michaels, JD, Weaver, AL, Phillips, PK, Brewer, JD, Roenigk, RK & Otley, CC 2011, 'Complications of cutaneous surgery in patients taking clopidogrel- containing anticoagulation', Journal of the American Academy of Dermatology, vol. 65, no. 3, pp. 584-591. https://doi.org/10.1016/j.jaad.2011.02.013
Cook-Norris, Robert H. ; Michaels, Jason D. ; Weaver, Amy L. ; Phillips, P. Kim ; Brewer, Jerry D. ; Roenigk, Randall K. ; Otley, Clark C. / Complications of cutaneous surgery in patients taking clopidogrel- containing anticoagulation. In: Journal of the American Academy of Dermatology. 2011 ; Vol. 65, No. 3. pp. 584-591.
@article{4e2e595287484058811a3146691fd78a,
title = "Complications of cutaneous surgery in patients taking clopidogrel- containing anticoagulation",
abstract = "Background: Most anticoagulants are not associated with increased risk of severe complications during cutaneous surgery, but no data exist on clopidogrel. Objective: We sought to determine frequency and severity of perioperative complications in patients taking clopidogrel-containing anticoagulation. Methods: This was a retrospective review of medical records of patients undergoing Mohs micrographic surgery at Mayo Clinic, Rochester, MN, while taking clopidogrel-containing anticoagulation between 2004 and 2008, compared with control subjects taking aspirin monotherapy or no anticoagulants. Results: In all, 220 patients taking clopidogrel-containing anticoagulation underwent 363 surgical procedures on 268 occasions. Severe complications occurred in 11 of 363 surgical sites in 10 cases. Clopidogrel-containing anticoagulation was 28 times more likely than no anticoagulation and 6 times more likely than aspirin monotherapy to result in severe complications after Mohs procedures (P <.001 and P =.022, respectively). Severe complications were 8 times more likely after Mohs procedures in patients taking both clopidogrel and aspirin than in control subjects taking aspirin monotherapy (P =.009). No statistically significant difference was found between patients taking clopidogrel monotherapy and control subjects not taking anticoagulants (P =.15). Patients experiencing severe complications were more likely to have larger postoperative surgical sites (P <.001). No thrombotic complications were encountered with discontinuation of clopidogrel-containing anticoagulation; a postoperative thrombotic complication occurred in one patient whose clopidogrel-containing anticoagulation regimen was modified. Limitations: Retrospective nature of study, possible recall bias as a result of telephone contact, and small number of severe complications were limitations, which reduced study power. Conclusion: Cutaneous surgery in patients taking clopidogrel-containing anticoagulation is associated with an increased risk of nonlife-threatening severe complications.",
keywords = "anticoagulation, aspirin, blood thinners, clopidogrel, cutaneous surgery, Mohs micrographic surgery",
author = "Cook-Norris, {Robert H.} and Michaels, {Jason D.} and Weaver, {Amy L.} and Phillips, {P. Kim} and Brewer, {Jerry D.} and Roenigk, {Randall K.} and Otley, {Clark C.}",
year = "2011",
month = "9",
doi = "10.1016/j.jaad.2011.02.013",
language = "English (US)",
volume = "65",
pages = "584--591",
journal = "Journal of the American Academy of Dermatology",
issn = "0190-9622",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Complications of cutaneous surgery in patients taking clopidogrel- containing anticoagulation

AU - Cook-Norris, Robert H.

AU - Michaels, Jason D.

AU - Weaver, Amy L.

AU - Phillips, P. Kim

AU - Brewer, Jerry D.

AU - Roenigk, Randall K.

AU - Otley, Clark C.

PY - 2011/9

Y1 - 2011/9

N2 - Background: Most anticoagulants are not associated with increased risk of severe complications during cutaneous surgery, but no data exist on clopidogrel. Objective: We sought to determine frequency and severity of perioperative complications in patients taking clopidogrel-containing anticoagulation. Methods: This was a retrospective review of medical records of patients undergoing Mohs micrographic surgery at Mayo Clinic, Rochester, MN, while taking clopidogrel-containing anticoagulation between 2004 and 2008, compared with control subjects taking aspirin monotherapy or no anticoagulants. Results: In all, 220 patients taking clopidogrel-containing anticoagulation underwent 363 surgical procedures on 268 occasions. Severe complications occurred in 11 of 363 surgical sites in 10 cases. Clopidogrel-containing anticoagulation was 28 times more likely than no anticoagulation and 6 times more likely than aspirin monotherapy to result in severe complications after Mohs procedures (P <.001 and P =.022, respectively). Severe complications were 8 times more likely after Mohs procedures in patients taking both clopidogrel and aspirin than in control subjects taking aspirin monotherapy (P =.009). No statistically significant difference was found between patients taking clopidogrel monotherapy and control subjects not taking anticoagulants (P =.15). Patients experiencing severe complications were more likely to have larger postoperative surgical sites (P <.001). No thrombotic complications were encountered with discontinuation of clopidogrel-containing anticoagulation; a postoperative thrombotic complication occurred in one patient whose clopidogrel-containing anticoagulation regimen was modified. Limitations: Retrospective nature of study, possible recall bias as a result of telephone contact, and small number of severe complications were limitations, which reduced study power. Conclusion: Cutaneous surgery in patients taking clopidogrel-containing anticoagulation is associated with an increased risk of nonlife-threatening severe complications.

AB - Background: Most anticoagulants are not associated with increased risk of severe complications during cutaneous surgery, but no data exist on clopidogrel. Objective: We sought to determine frequency and severity of perioperative complications in patients taking clopidogrel-containing anticoagulation. Methods: This was a retrospective review of medical records of patients undergoing Mohs micrographic surgery at Mayo Clinic, Rochester, MN, while taking clopidogrel-containing anticoagulation between 2004 and 2008, compared with control subjects taking aspirin monotherapy or no anticoagulants. Results: In all, 220 patients taking clopidogrel-containing anticoagulation underwent 363 surgical procedures on 268 occasions. Severe complications occurred in 11 of 363 surgical sites in 10 cases. Clopidogrel-containing anticoagulation was 28 times more likely than no anticoagulation and 6 times more likely than aspirin monotherapy to result in severe complications after Mohs procedures (P <.001 and P =.022, respectively). Severe complications were 8 times more likely after Mohs procedures in patients taking both clopidogrel and aspirin than in control subjects taking aspirin monotherapy (P =.009). No statistically significant difference was found between patients taking clopidogrel monotherapy and control subjects not taking anticoagulants (P =.15). Patients experiencing severe complications were more likely to have larger postoperative surgical sites (P <.001). No thrombotic complications were encountered with discontinuation of clopidogrel-containing anticoagulation; a postoperative thrombotic complication occurred in one patient whose clopidogrel-containing anticoagulation regimen was modified. Limitations: Retrospective nature of study, possible recall bias as a result of telephone contact, and small number of severe complications were limitations, which reduced study power. Conclusion: Cutaneous surgery in patients taking clopidogrel-containing anticoagulation is associated with an increased risk of nonlife-threatening severe complications.

KW - anticoagulation

KW - aspirin

KW - blood thinners

KW - clopidogrel

KW - cutaneous surgery

KW - Mohs micrographic surgery

UR - http://www.scopus.com/inward/record.url?scp=80051759625&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80051759625&partnerID=8YFLogxK

U2 - 10.1016/j.jaad.2011.02.013

DO - 10.1016/j.jaad.2011.02.013

M3 - Article

C2 - 21514003

AN - SCOPUS:80051759625

VL - 65

SP - 584

EP - 591

JO - Journal of the American Academy of Dermatology

JF - Journal of the American Academy of Dermatology

SN - 0190-9622

IS - 3

ER -