Purchase this article with an account.
A. Ryan, T. Saad, C. Kirwan, D. Keegan, R. Acheson; Maintenance of Per-Operative Anticoagulant Therapy for Vitreoretinal Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2553.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Antiplatelet and anticoagulant medications - acetylsalicylic acid (aspirin), clopidogrel (plavix) and warfarin- are commonly taken by patients undergoing vitreoretinal surgery. Aspirin, in particular, is widely prescribed in patients with diabetes mellitus. Increasing numbers of patients are undergoing percutaneous coronary intervention and require subsequent dual antiplatelet treatment with aspirin and clopidogrel for up to one year. Cessation of anticoagulant medications can have life-threatening consequences. Since 2003, five studies have indicated that the risk of bleeding complications during vitreoretinal procedures is small if anticoagulant therapy is maintained compared to the risk of withdrawing such treatment. The purpose of this study was to determine the risk of bleeding complications for patients undergoing vitreoretinal procedures within our unit following the introduction of a new protocol for maintaining anticoagulant therapy in the per-operative period.
We introduced a new protocol for per-operative management of all patients taking anticoagulants undergoing vitreoretinal procedures within our unit. Aspirin and clopidogrel therapy was not changed. Warfarin therapy was maintained to keep the international normalised ratio (INR) within the therapeutic range 2-3. Measures were taken to reduce the risk of intraoperative hypotony. Retinal bleeding was controlled by increasing the height of the infusion with or without diathermy. We prospectively recorded all intraoperative and postoperative bleeding complications. The study period was for one year from January to December 2009.
At six months (interim analysis), 58 vitreoretinal procedures were performed on patients taking anticoagulants. Twenty two patients had vitrectomy, 27 had vitrectomy with membrane peel with or without delamination, 8 had cryopexy and scleral buckling and 1 had cryopexy and intravitreal gas injection. Forty five patients were taking aspirin alone, 3 clopidogrel alone, 5 warfarin and 5 dual therapy with aspirin and clopidogrel. There were no serious intraoperative bleeding complications. One patient taking warfarin had postoperative vitreous cavity haemorrhage and hyphaema which spontaneously resolved within 2 weeks. One patient taking aspirin had postoperative vitreous cavity haemorrhage which cleared by 2 months. The one year results will follow.
Anticoagulant medications can be safely continued in the per-operative period for patients undergoing vitreoretinal surgery if appropriate measures are taken to minimise bleeding.
This PDF is available to Subscribers Only