Continuing warfarin during cutaneous surgery

The risk of haemorrhage from minor cutaneous surgical procedures has long been a concern in the treatment of patients receiving warfarin as anti-coagulation therapy. Interruption, alteration, hospital admission and monitoring have resource implications as well as the potential for complications. Therefore, we wanted to determine whether it was feasible to undertake typical minor plastic surgery procedures without altering patients' warfarin dosage regimens. We undertook a prospective study of 51 patients (age range 36 to 86), with 78 wounds, undergoing a range of minor cutaneous surgical procedures including excision biopsies, local flaps and skin grafts. The patients continued their normal warfarin regimen and the INR was checked on the day of surgery, ranging from 1.1 to 4.0. There were no problems encountered during surgery, but two patients presented with bleeding from a wound a few days post-operatively. We feel that it is unnecessary to modify warfarin regimens for minor cutaneous surgery. However, a well-briefed patient and experienced surgical management with good support facilities are a prerequisite for this.