The perioperative management of patients on antiplatelet agents and anticoagulants presenting for plastic surgical operations: a survey of current practice in the UK

A significant proportion of patients who present for plastic surgical procedures take aspirin or other antiplatelet agents (clopidogrel or nonsteroidal anti-inflammatory drugs) or are on anticoagulants (e.g. warfarin). Although there have been several reports in the literature regarding the perioperative management of patients presenting for dermatologic surgery, there have been no such reports pertaining to the wider scope of plastic surgical practice. In the absence of clear guidelines for the perioperative management of these patients presenting for plastic surgical practice, we have undertaken a pilot survey of the current practices of consultant plastic surgeons in the UK. The aims of this study were to determine whether there was uniformity of practice, and whether the modes of practice differed from those outlined in the literature for other related specialities. A postal survey of 235 plastic surgical consultants was conducted. The response rate was 48%. Overall, most respondents (84%) stated that their practice was primarily based on personal preference, and only 28% stated that it was based on the local Unit policy. Only 23% of the Consultants based their practice on evidence-based medicine. There appeared to be significant variations in current practice amongst plastic surgeons. Some aspects of practice were found to vary from those recommended in the literature for other related specialities. We hope that the findings of this study will highlight the significant non-uniformity of practice within this speciality and that this may form the basis for the development of clear guidelines of the entire spectrum of plastic surgery for the preoperative management of this group of patients in the future.