Postoperative stroke after stopping warfarin for cutaneous surgery.

BACKGROUND: Two patients undergoing cutaneous surgery had thromboembolic strokes within 1 week after surgery. Both patients had been taking warfarin for prevention of thromboembolism and warfarin was stopped 3-7 days prior to surgery.

OBJECTIVE: To examine the rationale and problems associated with preoperative warfarin discontinuation.

METHODS: Review of the medical literature.

RESULTS: When warfarin is stopped prior to surgery and restarted soon after surgery, the patient is at increased risk for thromboembolism. Although it is commonly believed that continuing warfarin during surgery is associated with an increased bleeding risk, for cutaneous surgery, this risk is extremely low and can be easily managed.

CONCLUSION: Warfarin should not be discontinued prior to cutaneous surgery because of the risk of thromboembolic stroke.