Antiplatelet and anticoagulation therapy in vitreoretinal surgery

Jae Ryung Oh, William E. Smiddy, Sung Soo Kim

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

• Purpose: To evaluate changes in the prevalence of antiplatelet (aspirin, clopidogrel) and anticoagulation (warfarin) therapy and its possible relationship to postoperative bleeding in vitreoretinal surgery (VRS) patients. • Design: Observational, retrospective case control study. • Methods: setting: University practice.study population: A total of 822 patents who underwent VRS during 3 intervals in 1994, 2004, and 2008.observation procedure: Retrospective chart review for 1994 and 2004, but contemporaneous in 2008.main outcome measures: Proportion using antiplatelets or anticoagulants, the incidence of early postoperative intraocular bleeding in patients, and clinical consequence of the hemorrhage. • Results: Thirty-one of 213 patients (14.6%) who underwent VRS in 1994, 103 of 361 patients (28.5%) in 2004, and 80 of 248 patients (32.3%) in 2008 had taken antiplatelet therapy (P < .001). The rates of anticoagulant therapy did not vary. The incidence of bleeding was higher (20.0%) in the patients who did not suspend antiplatelets than in those who did (9.6%) (P = .05, χ2 test), but this difference lost statistical significance in a multivariate analysis (P = .079). Anticoagulant was associated with intraocular hemorrhage at postoperative first day after vitrectomy (P = .03, Fisher exact test). No reoperation or failure of the surgery was attributable to the hemorrhage in anticoagulant or antiplatelet patients. • Conclusions: Use of antiplatelet agents has increased in patients undergoing vitreoretinal surgery but probably does not increase the risk of postoperative intraocular bleeding; however, when safe to suspend even for a short time the potential risk is further reduced. Anticoagulant use was associated with a higher risk, but without serious consequences. Working with a patient's medical doctor may allow safe suspension in some cases, which may further lower these risks.

Original languageEnglish
JournalAmerican Journal of Ophthalmology
Volume151
Issue number6
DOIs
Publication statusPublished - 2011 Jun 1
Externally publishedYes

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Vitreoretinal Surgery
Anticoagulants
Hemorrhage
Therapeutics
clopidogrel
Postoperative Hemorrhage
Patents
Platelet Aggregation Inhibitors
Vitrectomy
Incidence
Warfarin
Reoperation
Aspirin
Case-Control Studies
Suspensions
Multivariate Analysis
Observation
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

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Antiplatelet and anticoagulation therapy in vitreoretinal surgery. / Oh, Jae Ryung; Smiddy, William E.; Kim, Sung Soo.

In: American Journal of Ophthalmology, Vol. 151, No. 6, 01.06.2011.

Research output: Contribution to journalArticle

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abstract = "• Purpose: To evaluate changes in the prevalence of antiplatelet (aspirin, clopidogrel) and anticoagulation (warfarin) therapy and its possible relationship to postoperative bleeding in vitreoretinal surgery (VRS) patients. • Design: Observational, retrospective case control study. • Methods: setting: University practice.study population: A total of 822 patents who underwent VRS during 3 intervals in 1994, 2004, and 2008.observation procedure: Retrospective chart review for 1994 and 2004, but contemporaneous in 2008.main outcome measures: Proportion using antiplatelets or anticoagulants, the incidence of early postoperative intraocular bleeding in patients, and clinical consequence of the hemorrhage. • Results: Thirty-one of 213 patients (14.6{\%}) who underwent VRS in 1994, 103 of 361 patients (28.5{\%}) in 2004, and 80 of 248 patients (32.3{\%}) in 2008 had taken antiplatelet therapy (P < .001). The rates of anticoagulant therapy did not vary. The incidence of bleeding was higher (20.0{\%}) in the patients who did not suspend antiplatelets than in those who did (9.6{\%}) (P = .05, χ2 test), but this difference lost statistical significance in a multivariate analysis (P = .079). Anticoagulant was associated with intraocular hemorrhage at postoperative first day after vitrectomy (P = .03, Fisher exact test). No reoperation or failure of the surgery was attributable to the hemorrhage in anticoagulant or antiplatelet patients. • Conclusions: Use of antiplatelet agents has increased in patients undergoing vitreoretinal surgery but probably does not increase the risk of postoperative intraocular bleeding; however, when safe to suspend even for a short time the potential risk is further reduced. Anticoagulant use was associated with a higher risk, but without serious consequences. Working with a patient's medical doctor may allow safe suspension in some cases, which may further lower these risks.",
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