Some surgeons think that antiplatelet and anticoagulant therapies (aspirin, warfarin sodium and clopidogrel bisulphate) increase perioperative bleeding and infections. However, the current evidence base provides conflicting data with respect to the risk of true complications. In this case-control study a total of 9204 surgical procedures were analysed, comparing patients who continued to receive antiplatelets and / or anticoagulants during the perioperative period. The study showed that patients who continued to take warfarin during the perioperative period were almost four times as likely to have a bleeding complication and more than seven times as likely to have a postoperative infection. This is consistent with the elevated bleeding risk as haematomas and seromas often become secondarily infected. Aspirin use was not associated with increased complication rates in the study. The cohort taking clopidogrel (n = 11) was found not to be statistically associated with bleeding. In conclusion, although the study suggested that warfarin use in facial plastic surgery increases complications, the qualitative risk-benefit ratio would seem to favour continued use, given the lack of serious adverse events.

Anticoagulant complications in facial plastic and reconstructive surgery.
Kraft CT, Bellile E, Baker SR, Kim JC, Moyer JS.
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Bilal Gani Taib

University of Liverpool, UK.

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