Postoperative bleeding risk for cutaneous surgery in the head and neck region with continued phenprocoumon therapy |
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| Affiliation: | 1. Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany;2. Department of Oral and Maxillofacial Surgery (Head: PD Dr. Dr. Wolfgang Eichhorn), General Hospital Balingen, Balingen, Germany;3. Department of Neurology (Head: Prof. Dr. Christian Gerloff), University Medical Center Hamburg-Eppendorf, Hamburg, Germany;1. Division of Urogynecology and Minimally Invasive Gynecology, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Department of Obstetrics and Gynecology, Hershey, Pennsylvania;2. Division of Anatomic Pathology, Gynecologic Pathology Unit, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Department of Obstetrics and Gynecology, Hershey, Pennsylvania;3. Department of Pathology, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Department of Obstetrics and Gynecology, Hershey, Pennsylvania;4. Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania;1. Seton Spine and Scoliosis Center, Austin, TX 78731, USA;2. Capitol Anesthesiology Association, Austin, TX 78705, USA;1. Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera en México, Coyoacan, México;2. Servicio de Glaucoma, Hospital Dr. Luis Sánchez Bulnes, Coyoacan, México;1. Fatih University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey;2. Baskent University, Faculty of Medicine, Department of Urology, Ankara, Turkey;3. Baskent University, Faculty of Medicine, Department of Medical Genetics, Ankara, Turkey;4. Baskent University, Faculty of Medicine, Department of Pathology, Ankara, Turkey;1. Department of Maxillofacial Surgery, University Hospital Center, Place Victor Pauchet, 80054 Amiens Cedex, France;2. University of Picardie Jules Verne, Pôle santé 3, Rue DES LOUVELS 80036 AMIENS CEDEX 1, France;3. Facing Faces Institute, Amiens University Hospital Center, Place Victor Pauchet, 80054 Amiens Cedex, France;1. Department of Oral and Maxillofacial Surgery (Head: Young-Wook Park, D.D.S., Ph.D), College of Dentistry, Gangneung-Wonju National University, Gangneung 210-702, Republic of Korea;2. Face, Cheeks, Oral Surgery and Dental Clinic (Head: Szabó György, M.D., D.D.S), Faculty of Dentistry, Semmelweis University, Budapest, Hungary;3. Department of Mechanical Systems Engineering (Head: Jae Bong Choi, M.D., Ph.D), Hansung University, Seoul, Republic of Korea;4. Department of Biochemistry and Cell Biology (Head: In-San Kim, M.D., Ph.D), WCU Programme, CMRI, Skeletal Diseases Genome Research Centre, School of Medicine, Kyungpook National University, Daegu, Republic of Korea |
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| Abstract: | ![]()
In a total of 171 surgical procedures for lesions in the head and neck region in patients in whom phenprocoumon therapy was not stopped, 16 (9%) postoperative bleeding events were observed over a follow-up period of two weeks. Local measures were sufficient in all cases except one severe case where blood transfusion was needed and anticoagulant treatment was stopped for 7 days. The bleeding risk was significantly higher for the surgical procedures of the nose than those in other areas (21% versus 6%, P = 0.014), but was not influenced by the international normalized ratio (INR) of blood coagulation, size, site and type of the lesion, surgical procedure, and sex and age of the patients. The bleeding rate in patients not on any anticoagulation therapy was significantly lower (6/211 = 3%). Across both groups, just over 80% of the bleeding episodes were within the first two days (55% on the same day and 32% on the next day) of the surgery. No bleeding was recorded after 5 days. Our data suggest that cutaneous surgery in the head and neck region can be safely performed with continued phenprocoumon therapy in most cases in an INR range of 1.3–3.4, but rarely severe bleeding does occur and can be managed with a close-contact follow-up and with 24-h on call services during the first two days postoperatively. |
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| Keywords: | Cutaneous surgery Anticoagulation therapy Phenprocoumon Bleeding Head and neck surgery |
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