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The effects of aspirin and warfarin therapy on haemorrhage in vitreoretinal surgery

  1. Niro Narendran,
  2. Tom H Williamson

Article first published online: 11 MAR 2003

DOI: 10.1034/j.1600-0420.2003.00020.x

Issue

Acta Ophthalmologica Scandinavica

Acta Ophthalmologica Scandinavica

Volume 81, Issue 1, pages 38–40, February 2003

Additional Information

How to Cite

Narendran, N. and Williamson, T. H. (2003), The effects of aspirin and warfarin therapy on haemorrhage in vitreoretinal surgery. Acta Ophthalmologica Scandinavica, 81: 38–40. doi: 10.1034/j.1600-0420.2003.00020.x

Author Information

  1. Department of Ophthalmology, St Thomas' Hospital, London, UK

*Tom H Williamson, MD Department of Ophthalmology St Thomas' Hospital Lambeth Palace Road London SE1 7EH UK Tel: + 44 20 7928 9292 Fax: + 44 20 7580 6855 Email: tom@retinasurgery.co.uk

Publication History

  1. Issue published online: 11 MAR 2003
  2. Article first published online: 11 MAR 2003
  3. Received on July 8th, 2002.; Accepted on September 23rd, 2002.

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Keywords:

  • anticoagulation;
  • aspirin;
  • choroidal haemorrhage;
  • vitreoretinal surgery;
  • vitreous haemorrhage;
  • warfarin

Abstract.

Background:  No substantial recommendations exist regarding the management of anticoagulant drugs prior to ocular surgery. Stopping anticoagulation can cause fatal emboli, but sight-threatening bleeds may occur if anticoagulation is continued. We examined the effects of anticoagulation on vitreoretinal surgery.

Methods:  Clinical details were prospectively entered on a database. The anticoagulant status of 541 consecutive patients undergoing vitreoretinal surgery was recorded.

Results:  Sixty patients in the study were taking aspirin and seven were taking warfarin. There were 11 cases of choroidal haemorrhage, one of which involved a warfarin user. Of 325 retinal detachment repairs, 21 (6.5%) had preoperative vitreous haemorrhages. Two of these patients were on aspirin and two were on warfarin. Sixty-six vitrectomies were performed for diabetic vitreous haemorrhages, of which nine re-bled postoperatively. One of these patients was taking warfarin. The association of warfarin with bleeding was statistically significant (relative risk 6.185).

Conclusion:  Anticoagulation had no effect on the number of significant perioperative (choroidal) haemorrhages. Aspirin had little effect on bleeding during vitreoretinal surgery. Warfarin, however, was associated with bleeding complications. We suggest that aspirin should not be stopped prior to surgery. Warfarin may be stopped if the patient's thromboembolic risk is low.

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