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National Survey on Antithrombotic Management in Minor Hand Surgery: Current Practices in Canada.
Justin Haas, MD, BSc
1; Thoma Achilles, MD, MSc, FRCS(C)
2; Minoo Aminnejad, PhD
1; Forough Farrokhyar, MPhil, PhD
3; Helene Retrouvey, MD, PhD, FRCS(C)
11McMaster University, Hamilton, ON, Canada; 2Department of Surgery, Division of Plastic Surgery, St. Joseph's Healthcare and McMaster University, Hamilton, ON, Canada; 3Plastic Surgery, McMaster University, Hamilton, ON, Canada
Introduction: Temporarily withholding antithrombotic medications for surgical procedures has been shown to increase the risk of thromboembolic events. Many patients undergoing minor hand surgeries take these medications, necessitating careful perioperative management by surgeons. However, existing guidelines do not specify the bleeding risks associated with minor hand procedures, and there is a lack of consensus for managing antithrombotic therapy in this context. This study aims to elucidate the current perioperative management strategies employed by Canadian plastic surgeons for patients undergoing minor hand surgeries while taking antithrombotic medications.
Methods: A cross-sectional, descriptive study using an electronic survey was conducted among Canadian plastic surgeons in 2024. Surgeons were asked general clinical questions in addition to whether they would hold antithrombotic medications for various clinical scenarios, including cyst excision, trigger finger release, and carpal tunnel release.
Results: 74 surgeons participated in this study. 93.7% of surgeons consider the aforementioned minor hand procedures to have a "low” bleeding risk. This perception decreased to 71.2% for patients on Apixaban and 59.9% for those on Warfarin. Additionally, 26.6% of surgeons indicated they would hold Aspirin, 37.8% would hold Warfarin, and 47.7% would hold Apixaban. Surgeon demographic data (gender, age, years in practice, geographic location), fellowship training in hand surgery, access to thrombosis experts, the utilization of guidelines, and tourniquet use were not significantly associated with probability of choosing to hold anti-thrombotic medications.
Conclusions: The findings of this study indicate that there is practice variation in hand surgery that diverges from currently available guidelines. Nearly all Canadian plastic surgeons consider common minor hand procedures to have a low risk of bleeding, but this perception changes with anticoagulant use. A significant number choose to withhold antithrombotic medications, diverging from recommendations for procedures with a low risk of bleeding. This discrepancy likely arises from the increased perceived bleeding risk associated with anticoagulant use—a nuance not adequately addressed in current guidelines.
Future research investigating the safety of various perioperative antithrombotic management strategies in hand surgery and updates to existing antithrombotic guidelines are warranted.
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