Pre-operative tranexamic acid in patients on warfarin and anti-platelets undergoing excision of skin cancers: A pilot study

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Praveen C V

Ashford St Peters Hospital NHS Foundation Trust, UK

: J Otol Rhinol

Abstract

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Tranexamic acid is anti-fibrinolytic and is used to prevent and treat blood loss in a variety of situations, such as dental procedures, obstetric haemorrhage and surgeries with high risk of blood loss. Skin cancers are very common especially in elderly. Many elderly patients have significant co-morbidities and are on anti-platelets or anti-coagulants among other medications. British Society of Dermatological Surgery has issued guidelines regarding patients on these medications. Some patients such as those who had recent stroke cannot stop these medications without consequences. Those who are on these medications bleed excessively during the operation which can even compromise the graft or flap survival post-operatively. A pilot study was carried out on those patients who had high INR with skin cancers, if pre-operative tranexamic acid was helpful in reducing blood loss. Sixteen patients who had skin cancers with significant co-morbidities and were on anti-coagulants or anti-platelets medications were considered for this pilot. Majority of these patients had high INR (range 2-3.5) and either had squamous cell cancer or melanoma and recent cardiovascular or neurological problems such as stroke or cardiac stent insertion. They had intravenous tranexamic acid half an hour before wide excision of skin cancer and full thickness skin graft or various flaps for wound closure. It was observed that the blood loss was significantly less in these who had pre-op tranexamic acid with very little side effects. There was neither post-op bleeding nor haematoma and graft failure. Patients who could not stop anticoagulants or anti-platelets medications undergoing surgery under local anaesthesia were asked to continue with their medications as per guidelines issued by British Society of Dermatological Surgery. Pre-op tranexamic acid can be given to patients who have skin cancer but cannot stop anti-platelets or anticoagulants because of comorbidities.

Biography

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Praveen C V is presently working as Locum Consultant at Ashford & St Peters and Royal Surrey Hospitals. He has experience in Head and Neck Surgery, and Rhinology and management of skin cancers.