Hi Amy!
There are many options to choose from for skin tears when patient is on a blood thinner. In my practice, I find that the newer anticoagulants as well as ASA also can be problematic. Skin tears can be classified into three separate types - fissures (no tissue loss), flaps (partial skin loss) and total flap loss. Best practice recommended by ISTAP (International Skin Tear Advisory Panel) for topical management includes non-adherent dressings, foam dressings, 2-octylcyanoacrylate application, alginates, hydrofibers and acrylates.
That's a pretty broad recommendation! It will depend on your assessment.....
If actively bleeding or oozing - hydrofibers, alginates applied with pressure and then a secondary dressing with will provide a non-traumatic removal can suffice. Use of a 2-octylcyanoacrylate has the benefit of not needing a secondary dressing, as it binds with the proteins in the blood to quickly form a coagulum. If your patient is at risk of reinjuring the area from friction/shear, the 2-octylcyanoacrylate will not provide much protection.
Silicone sheeting or a silicone adhesive dressings (usually foam or hydrofiber base) can work well if there is minimal drainage. Consideration as to what the patient received the skin tear from is also in order....if the wound was "dirty" or "clean" (relatively speaking, of course!) In the case of a wound exposed to visible dirt/debris or if the patient has a high risk for infection (e.g. lymphedema and skin tear is on the leg; patient on chemo,etc.) placing an antimicrobial dressing may help reduce bioburden.
Iodine based products and film dressings are not recommended by ISTAP. Skin closure strips are not viwed favorably in the elderly of those with skin changes related to steroids.
Dressing selection can be difficult in skin tears due to the wide range of evidence. For a good read, the ISTAP Consensus Statement can be accessed at:
https://journals.lww.com/aswcjournal/Fulltext/2016/01000/The_Art_of_Dressing_Selection__A_Consensus.10.aspx
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