Abstract：
Perioperative management of antithrombotic agents requires practical and medical considerations. Discontinuing antithrombotic therapies increases the risk of thrombotic adverse events including cerebrovascular accidents, myocardial infarction, pulmonary embolism, deep vein thrombosis, and retinal artery occlusion. Conversely, continuation of antithrombotic therapy during surgical procedures has associated bleeding risks. Currently, no guidelines exist regarding management of antithrombotic agents in the perioperative period for cutaneous surgeries and practice differs by surgeon. Here, we review the data on antithrombotic medications in patients undergoing cutaneous surgery including medication-specific surgical and postoperative bleeding risk if the medications are continued, and thromboembolic risk if the medications are interrupted. Specifically, we focus on vitamin K antagonist (VKA) (warfarin), direct-acting oral anticoagulants (DOAC) (rivaroxaban, apixaban, edoxaban, dabigatran), antiplatelet medications (aspirin, clopidogrel, prasugrel, ticagrelor, dipyridamole), unfractionated heparin, low molecular weight heparin (enoxaparin and dalteparin), fondaparinux, bruton tyrosine kinase inhibitors (BTKi) (ibrutinib, acalabrutinib), and dietary supplements (i.e., garlic, ginger, gingko).
摘要：
抗血栓药物的围手术期管理需要实际和医学考虑。停止抗血栓治疗会增加血栓不良事件的风险，包括脑血管意外。心肌梗塞,肺栓塞,深静脉血栓形成,和视网膜动脉阻塞.相反，在外科手术期间继续进行抗血栓治疗有相关的出血风险.目前,目前尚无关于皮肤手术围手术期抗血栓药物管理的指南,并且手术实践因外科医生而异.这里,我们回顾了接受皮肤手术的患者的抗血栓药物的数据，包括药物特异性手术和术后出血风险，如果继续药物治疗，和血栓栓塞的风险，如果药物中断。具体来说,我们专注于维生素K拮抗剂（VKA）（华法林），直接作用口服抗凝剂（DOAC）（利伐沙班，阿哌沙班,edoxaban,达比加群)，抗血小板药物（阿司匹林，氯吡格雷,普拉格雷,替格瑞洛,双嘧达莫)，普通肝素,低分子量肝素（依诺肝素和达肝素），磺达肝素,布鲁顿酪氨酸激酶抑制剂（BTKi）（ibrutinib，acalabrutinib),和膳食补充剂(即，大蒜，大蒜Ginger,银杏）。
