Conflict/competing interest: No stated conflict of interest.
Maintenance of perioperative antiplatelet and anticoagulant therapy for vitreoretinal surgery
Article first published online: 10 DEC 2012
© 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists
Clinical & Experimental Ophthalmology
Volume 41, Issue 4, pages 387–395, May/June 2013
How to Cite
Ryan, A., Saad, T., Kirwan, C., Keegan, D. J. and Acheson, R. W. (2013), Maintenance of perioperative antiplatelet and anticoagulant therapy for vitreoretinal surgery. Clinical & Experimental Ophthalmology, 41: 387–395. doi: 10.1111/ceo.12017
Funding sources: No stated funding sources.
- Issue published online: 5 JUN 2013
- Article first published online: 10 DEC 2012
- Accepted manuscript online: 24 OCT 2012 05:32PM EST
- Manuscript Accepted: 13 AUG 2012
- Manuscript Received: 24 JAN 2012
- anti-platelet agents;
- scleral buckling;
- vitreoretinal surgery
The objective of this study was to prospectively assess the risk of bleeding from vitreoretinal surgery in a continuous unbiased cohort of patients taking unsuspended antiplatelet or anticoagulant therapy.
Prospective hospital-based study.
Eighty-five patients taking unsuspended aspirin, clopidogrel and/or warfarin therapy undergoing all forms of vitreoretinal surgery at The Mater Misericordiae University and The Mater Private Hospital, Dublin, Ireland.
Consecutive patients undergoing vitreoretinal surgery taking unsuspended antiplatelet or anticoagulant therapy over a 1-year period were included in this prospective study to evaluate the intraoperative and postoperative bleeding complications.
Main Outcome Measures
The intraoperative and postoperative bleeding rates.
One hundred and seven vitreoretinal procedures were performed on 85 patients taking unsuspended antiplatelet or anticoagulant therapy. The intraoperative bleeding rate was 23%, the majority of which consisted of mild bleeding into the vitreous cavity during vitrectomy. The postoperative bleeding rate was 22%, consisting of 3.7% anterior chamber haemorrhage, 11% dispersed vitreous cavity haemorrhage, 4.7% dense vitreous cavity haemorrhage, 0.9% subretinal haemorrhage and 1.9% localized choroidal haemorrhage. The single greatest significant independent predictor of intraoperative bleeding was proliferative diabetic retinopathy and of postoperative bleeding was the presence of diabetes mellitus.
There were no cases of uncontrolled intraoperative haemorrhage or serious postoperative choroidal haemorrhage. Mild haemorrhagic oozing during vitrectomy and dispersed vitreous cavity haemorrhage postoperatively were common. For the majority of patients taking antiplatelet or anticoagulant medication, these agents can be safely continued in the vitreoretinal surgical perioperative period.