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Thrombozytenaggregationshemmer und Antikoagulanzien

Umgang mit Blutverdünnern in der Dermatochirurgie

Platelet inhibitors and anticoagulants

Managing blood thinners in dermatosurgery

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Zusammenfassung

Viele dermatochirurgische Patienten erhalten eine antikoagulative oder thrombozytenhemmende Medikation. Das perioperative Management dieser Medikationen ist uneinheitlich und von Ängsten vor Blutungskomplikationen geprägt. Die in Studien nachgewiesenen Raten an postoperativen Blutungen unter dieser Medikation sind jedoch nur moderat erhöht. Die klinische Erfahrung zeigt keine nennenswerte Zunahme von Blutungsereignissen peri- oder postoperativ. Im Zuge einer Risikoabwägung muss die Gefahr thromboembolischer und thrombotischer Komplikationen nach Ab- oder Umsetzen höher gewichtet werden als ein blutungsbedingtes Operationsrisiko. Deshalb sollte nach Erfahrung der Autoren bei dermatochirurgischen Eingriffen die medikamentöse Blutverdünnung in aller Regel beibehalten werden. Ein generelles Bestimmen von Gerinnungsparametern erscheint präoperativ nicht sinnvoll und kann auf ausgewählte Patientengruppen beschränkt werden.

Abstract

Many patients requiring dermatologic surgery are taking anticoagulants or antiplatelet agents. The perioperative management of these drugs is not standardized and affected by fear of bleeding complications. Studies show only moderate increase in bleeding complications while taking these drugs. Our clinical experience shows no significant peri- or postoperative bleeding. As part of a risk assessment, thromboembolic complications outweigh any bleeding risk of surgery. Therefore, in the experience of the authors, blood thinning drugs should be continued before and during dermatosurgical procedures. General assessment of laboratory parameters concerning coagulation or platelet function is not necessary and can be restricted to selected subgroups of patients.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Löser und A. Nast geben an, dass kein Interessenkonflikt besteht. U. Zeymer ist als Berater für folgende Firmen tätig: Bayer, Sanofi, BMS, Pfizer, Medicines Company, Novartis, Lilly, Astra­Zeneca, Daiichi Sankyo, Boehringer Ingelheim. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to C. Löser.

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Löser, C., Zeymer, U. & Nast, A. Thrombozytenaggregationshemmer und Antikoagulanzien. Hautarzt 64, 553–557 (2013). https://doi.org/10.1007/s00105-013-2543-z

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  • DOI: https://doi.org/10.1007/s00105-013-2543-z

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