warfarin and Facial-Neoplasms

Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Aspirin; Atrial Fibrillation; Brain Damage, Chronic; Case Management; Contraindications; Craniotomy; Decompression, Surgical; Diabetes Complications; Evidence-Based Medicine; Facial Neoplasms; Fibrin Tissue Adhesive; Hemorrhage; Heparin; Heparin, Low-Molecular-Weight; Humans; Hypercholesterolemia; Hypertension; Infarction, Middle Cerebral Artery; International Normalized Ratio; Intracranial Embolism; Male; Melanoma; Middle Aged; Mohs Surgery; Paresis; Postoperative Complications; Preoperative Care; Prospective Studies; Retrospective Studies; Skin Neoplasms; Skin Transplantation; Thrombolytic Therapy; Warfarin

Other than the classic skin necrosis induced by oral anticoagulants (OAC) in patients with protein C and S deficiencies, other types of OAC induced-skin ulcers are little known. Herein, we describe an original case of recurrent pyoderma gangrenosum (PG)-like ulcers induced by OAC.. A 70-year-old female heart-transplant recipient presented deep, hyperalgesic and quickly-spreading necrotic ulceration of the right leg 6 weeks after starting oral anticoagulant therapy with fluindione. Histological analysis revealed dermal infiltrate containing polynuclear neutrophils, which accords with the histopathological diagnosis of leukocytoclastic vasculitis or PG. Infectious, autoimmune and thrombophilic causes were ruled out. Fluindione was withdrawn and the ulcer healed completely within a month. Six months later, right leg ulceration recurred two weeks after the patient resumed fluindione but healed within 1 month of discontinuation of the drug. An OAC from another chemical family (warfarin) was then introduced, with further recurrence of ulceration after 2 weeks of treatment.. The chronology of events and the negativity of aetiological explorations allowed a diagnosis to be made of OAC-induced skin ulcer, a rare complication of which the pathophysiology is unclear. This is the first case of PG-like ulcers induced by OAC.

Topics: Aged; Anticoagulants; Bed Rest; Carcinoma, Basal Cell; Diagnosis, Differential; Drug Eruptions; Drug Substitution; Facial Neoplasms; Female; Heart Transplantation; Humans; Hyperalgesia; Molecular Structure; Monoclonal Gammopathy of Undetermined Significance; Phenindione; Postoperative Complications; Pyoderma Gangrenosum; Recurrence; Skin Neoplasms; Skin Ulcer; Thrombophlebitis; Vasculitis, Leukocytoclastic, Cutaneous; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Antifibrinolytic Agents; Carcinoma, Basal Cell; Facial Neoplasms; Female; Humans; Mohs Surgery; Postoperative Hemorrhage; Skin Neoplasms; Vitamin K; Warfarin

Many patients who have operations on the head and neck for skin cancer also take warfarin to prevent thromboembolic events, and there is still debate about whether treatment should be continued, adjusted, or temporarily stopped. The main concern is to balance the risk of haemorrhagic and thromboembolic events. In this prospective controlled study we compared bleeding complications in operations for skin cancer of the head and neck between 86 patients who took warfarin (100 tumours) and 87 (100 tumours) who did not. Surgeons of different grades did the operations under the guidance of the same consultant. All those on warfarin had above normal international normalised ratios (INRs) (mean (SD) 2.5 (0.51), mode 2.6, range 1.1-4.0). In the warfarin group 8% of excisions had a bleeding complication compared with 9% in the control group. One patient in each group suffered a severe bleed that required a return to theatre. The difference in tendency to bleed between the groups was not significant (p=0.30), and the site and type of reconstruction did not influence the risk of bleeding significantly. This study shows that patients on warfarin who are within the normal therapeutic range, can be operated on safely for skin cancer by all levels of trained staff.

Topics: Anticoagulants; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Case-Control Studies; Dermatologic Surgical Procedures; Facial Neoplasms; Follow-Up Studies; Head and Neck Neoplasms; Humans; International Normalized Ratio; Plastic Surgery Procedures; Postoperative Hemorrhage; Prospective Studies; Risk Factors; Safety; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Thromboembolism; Warfarin

Anticoagulant treatment with warfarin is an essential therapy in patients with prosthetic heart valves and atrial fibrillation to prevent thromboembolisms. The question whether to stop warfarin treatment in patients undergoing cutaneous surgery is debatable.. To evaluate the outcome of surgery in patients that were treated with warfarin and underwent excisional and Mohs surgeries.. Warfarin therapy was continued in all patients that underwent excisional and Mohs surgery in our practice from November 1999 to November 2000. Perioperative complications such as bleeding and cosmetic outcome are evaluated.. A total of 560 patients underwent Mohs surgery and 530 patients underwent excisional surgery. Sixteen patients (1.5%) were treated with coumadin with international normalized ratio (INR) values within the therapeutic values. Seventy-seven patients that underwent surgery on the same days as the warfarin-treated patients served as the control group. Intraoperative bleeding was easily controlled and postoperative bleeding was not recorded in any of the patients. All wounds healed without any complication, including full-thickness grafts.. Coumadin treatment should be continued in patients undergoing cutaneous surgery. This will decrease the risk of thromboembolic events.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Blood Loss, Surgical; Contraindications; Dermatologic Surgical Procedures; Facial Neoplasms; Humans; Middle Aged; Mohs Surgery; Skin Neoplasms; Thromboembolism; Warfarin