Delayed-Onset Hematomas Following Mohs Surgery in Patients Taking a Direct Oral Anticoagulant

Direct factor Xa inhibitors or direct oral anticoagulants, like apixaban, are used to reduce the risk of stroke, deep vein thrombosis, and pulmonary embolism. It is essential that patients prescribed these drugs follow the instructions carefully. When a patient needs surgery and is on a direct oral anticoagulant, the question arises as to whether they should stop taking it before the elective surgery. There are currently no well-established guidelines instructing whether a patient should discontinue taking them before a Mohs procedure. A Mohs procedure is a precise surgery that removes skin cancers. We describe two cases of delayed-onset hematoma formation following Mohs micrographic surgery and reconstruction in patients taking direct oral anticoagulants not withheld prior to the procedure. Due to the possible uniqueness of late-onset hematoma formation greater than two weeks post-operatively in patients taking apixaban, we wanted to bring this event to the attention of other physicians. This report highlights the need to instruct patients on the possible complications of continuing the prescription and the importance of consulting the prescribing doctor before telling the patient to cease taking the drugs.