Abstract
Purpose :
Glaucoma surgery in anticoagulated patients poses unique challenges. There is currently no consensus on perioperative management of antithrombotics for glaucoma surgeries, and the new non-vitamin K antagonist oral anticoagulants (NOACs) have introduced further uncertainty. Our purpose was to survey the practice patterns of glaucoma specialists on perioperative management of antithrombotic agents in patients undergoing glaucoma surgery.
Methods :
An anonymous cross-sectional survey was sent to members of the American Glaucoma Society (AGS) to investigate ophthalmologists’ usual practice regarding antithrombotic therapy prior to, during and after trabeculectomies and glaucoma drainage implantations (GDI).
Results :
One hundred and six surgeons responded to our survey. For trabeculectomies, majority of surgeons reported stopping P2Y12 inhibitors, NOACs, and warfarin (55%, 56% and 64% respectively) while 49 out of 104 (47%) surgeons routinely stop aspirin (ASA) before surgery (Figure 1). Similarly, for GDI, warfarin (54%) was most commonly stopped pre-operatively, followed by P2Y12 inhibitors and NOACS (both 49%), and ASA (42%). The majority of the surgeons who discontinue antithrombotic therapy reported doing so 6 days prior to surgery for aspirin, 3-5 days before surgery for P2Y12 inhibitors and warfarin, and either 48 or 72 hours before surgery for NOACs. Of those who stop warfarin and NOACs, the majority routinely liaise with patient’s internist or general practitioner. Most surgeons resumed each antithrombotic within 1-day post-operatively, however almost half of those same surgeons (55% and 42% for warfarin, 46% and 53% for NOACs, for trabeculectomies and GDI respectively) said they will occasionally delay resuming greater than 1-day. The type of glaucoma surgery affects the decision to stop an antithrombotic in 53% of surgeons. Of those surgeons, 78% are more likely to stop an antithrombotic for trabeculectomies, 7% for GDI, and 15% for minimally invasive glaucoma surgeries (MIGS).
Conclusions :
There is variability in the perioperative management of antithrombotic therapy among glaucoma surgeons with a considerable proportion reporting not stopping these agents pre-operatively. Further evidence-based guidelines are required to provide recommendations and address variations in practice.
This is a 2021 ARVO Annual Meeting abstract.