Purchase this article with an account.
T.–A.Y. Shih, S.K. Law, B.J. Song, J. Caprioli; Hemorrhagic Complications from Glaucoma Surgery in Patients on Anticoagulation Therapy or Antiplatelet Aggregation Therapy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5492.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To determine the incidence of and risk factors for hemorrhagic complications in patients on anticoagulation therapy (ACT) or antiplatelet aggregation therapy (APAT) before glaucoma surgery.
The medical records of patients who had glaucoma surgeries between July 1998 and March 2005 and were receiving ACT or APAT were reviewed. ACT includes warfarin, heparin, or enoxaparin. APAT includes aspirin, nonsteroidal anti–inflammatory agents, clopidogrel, anagrelide, or dipyridamole. Glaucoma surgery included trabeculectomy or tube shunt procedures with or without cataract extraction with intraocular lens implantation. The first eye of each patient that had glaucoma surgery was enrolled. Incidence of hemorrhagic complications included hyphema >20% of anterior chamber, blood clot in anterior chamber blocking the aqueous flow, suprachoroidal hemorrhage, vitreous hemorrhage, or macular hemorrhage, was calculated. Risk factors for hemorrhagic complications were analyzed by comparing patients with and without hemorrhagic complications.
331 patients (331 eyes) were on either an ACT or APAT prior to their glaucoma surgeries. 49 patients (14.8%) were on ACT or combination of ACT and APAT, and 282 patients (85.2%) on APAT only. 13 (26.5%) of the 49 patients on ACT and 83 (29.4%) of the 282 patients on APAT had bleeding complications. Patients whose ACT was continued during the glaucoma surgery had a higher, but statistically insignificant, rate of hemorrhagic complications than patients whose ACT was discontinued before surgery (36.4%, 18.5%, respectively, p=0.279). Comparison of patients with and without hemorrhagic complications, patients with hemorrhagic complications had higher rates of diagnosis of diabetes mellitus (p=0.027), tube shunt procedure (p<0.0001), and secondary glaucoma subtypes other than primary open angle, angle closure glaucoma or neovascular glaucoma (p<0.001).
In patients who were on ACT or APAT, increased rates of bleeding complications from glaucoma surgery may be associated with the diagnosis of diabetes mellitus, tube shunt procedure, and certain types of secondary glaucoma.
This PDF is available to Subscribers Only