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Maintenance of perioperative antiplatelet and anticoagulant therapy for vitreoretinal surgery
Author(s) -
Ryan Andrea,
Saad Tahira,
Kirwan Caitriona,
Keegan David J,
Acheson Robert W
Publication year - 2012
Publication title -
clinical and experimental ophthalmology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.3
H-Index - 74
eISSN - 1442-9071
pISSN - 1442-6404
DOI - 10.1111/ceo.12017
Subject(s) - medicine , vitrectomy , surgery , perioperative , prospective cohort study , aspirin , anticoagulant , clopidogrel , warfarin , anticoagulant therapy , diabetic retinopathy , diabetes mellitus , anesthesia , atrial fibrillation , visual acuity , endocrinology
Background The objective of this study was to prospectively assess the risk of bleeding from vitreoretinal surgery in a continuous unbiased cohort of patients taking unsuspended antiplatelet or anticoagulant therapy. Design Prospective hospital‐based study. Participants Eighty‐five patients taking unsuspended aspirin, clopidogrel and/or warfarin therapy undergoing all forms of vitreoretinal surgery at T he M ater M isericordiae U niversity and T he M ater P rivate H ospital, D ublin, I reland. Methods Consecutive patients undergoing vitreoretinal surgery taking unsuspended antiplatelet or anticoagulant therapy over a 1‐year period were included in this prospective study to evaluate the intraoperative and postoperative bleeding complications. Main Outcome Measures The intraoperative and postoperative bleeding rates. Results One hundred and seven vitreoretinal procedures were performed on 85 patients taking unsuspended antiplatelet or anticoagulant therapy. The intraoperative bleeding rate was 23%, the majority of which consisted of mild bleeding into the vitreous cavity during vitrectomy. The postoperative bleeding rate was 22%, consisting of 3.7% anterior chamber haemorrhage, 11% dispersed vitreous cavity haemorrhage, 4.7% dense vitreous cavity haemorrhage, 0.9% subretinal haemorrhage and 1.9% localized choroidal haemorrhage. The single greatest significant independent predictor of intraoperative bleeding was proliferative diabetic retinopathy and of postoperative bleeding was the presence of diabetes mellitus. Conclusions There were no cases of uncontrolled intraoperative haemorrhage or serious postoperative choroidal haemorrhage. Mild haemorrhagic oozing during vitrectomy and dispersed vitreous cavity haemorrhage postoperatively were common. For the majority of patients taking antiplatelet or anticoagulant medication, these agents can be safely continued in the vitreoretinal surgical perioperative period.