Aliano Kristen, Korsh Jessica, Davenport Thomas

1. Outcomes of Skin Grafting in Patients Taking
Anticoagulants
Kristen Aliano MD, Jessica Korsh MS, and Thomas Davenport MD
Background
Many surgical patients take anticoagulant
medications:
Clopidogrel
Aspirin
Warfarin
Enoxaparin
These drugs are taken for a variety of
serious medical problems:
Atrial fibrillation
Myocardial infarction
Deep vein thrombosis
Pulmonary embolism
Stroke
Little research has been published
regarding the perioperative use of these
medications in patients undergoing split-
thickness and full-thickness skin grafting
There are no current guidelines regarding
the perioperative use of these medications
in patients undergoing cutaneous
procedures
Objective
Aspirin
To investigate the surgical complications
in skin graft patients taking medications
that inhibit primary or secondary
hemostasis
Methods
Using ICD-9 codes, we established a
cohort of patients who underwent skin
grafting by a single plastic surgeon over
the course of one year
We then reviewed the medication
records of each individual in the cohort in
order to elucidate which patients were
taking aspirin, clopidogrel, warfarin, or
enoxaparin.
The outcomes of those on anticoagulant
medications were then examined
Results
 43 patients in the cohort
13 were taking one or more
anticoagulant medications:
10 female and 3 make
Average Age: 72.6 years
7 patients took warfarin alone
1 patient took warfarin and
enoxaparin
1 patient took clopidogrel and
warfarin
1 patient took clopidogrel alone
3 patients took aspirin alone
Reasons for anticoagulant therapy:
Atrial fibrillation
CAD
PVD
Strokes/TIAs
Factor V Leiden
Congenital heart disease
Essential thrombocytosis
Rheumatic heart disease
All successfully underwent skin
grafting with wound VAC placement
100% graft take
No failures
No blood transfusions required
Conclusion
Although our sample size is
relatively small, we feel that there is
no increased risk of bleeding
complications in patients taking
antithrombotic medications while
undergoing skin grafting.
The risks of discontinuing the
medications prior to surgery may
outweigh any potential benefit of
minimizing intra- and post-operative
bleeding