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Nathan Pezda, Asheesh Tewari; Warfarin in Vitreoretinal Surgery: A Systematic Review. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6126.
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Systemic anticoagulation is common in the demographic of patients typically undergoing vitreoretinal surgery. Cessation of anticoagulation can place the patient at risk for life threatening conditions. However, continuation of anticoagulation may create hemorrhagic ocular complications. The objective of this study is to evaluate warfarin use during vitreoretinal surgery, perform evidence synthesis for complications related to its use, and make evidence based recommendations for its continuation or discontinuation prior to vitreoretinal surgery.
A comprehensive systematic review of research literature on the use of warfarin during vitreoretinal surgery. A total of 86 patients (selected studies) receiving warfarin anticoagulation and vitreoretinal surgery, including vitrectomy and scleral buckle, were examined. Data reviewed included surgical procedure, international normalized ratio (INR) value at time of surgery, and any ocular complications attributable to anticoagulation. Data was compiled and appropriate statistical analysis was performed.
Uncommmon complications included suprachoroidal hemorrhage, post-operative hemorrhage (hyphema, vitreous hemorrhage), and subretinal hemorrhage from external drainage of subretinal fluid. Suprachoroidal hemorrhage occurred in 5%, external drainage occurred in 1%. Patients with elevated INR levels at the time of surgery (above therapeutic levels) appeared to be at increased risk of complications.
There does not appear to be strong evidence for discontinuing anticoagulation prior to vitreoretinal surgery. However, data found a trend of increased complications in patients who had higher than therapeutic levels of anticoagulation. Considering the increased number of surgeries being performed in non hospital based surgical centers, determination of INR levels may be appropriate prior to surgery.
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