6533b86dfe1ef96bd12c9c32

RESEARCH PRODUCT

Maintenance of anticoagulant and antiplatelet agents for patients undergoing vitreoretinal surgery

subject

description

International audience; Purpose: To establish the prevalence of anticoagulant, aspirin, and clopidogrel use in patients undergoing vitreoretinal surgery, and to compare the outcome of peribulbar anesthesia between users and non-users. Materials and Methods: We conducted a retrospective case series in one academic center between January and June 2009. We analyzed the chart of 239 eyes who underwent posterior segment surgery with peribulbar anesthesia. Data included age, reasons for anticoagulant and/or antiplatelet agents, operative procedure, history of diabetes mellitus, high blood pressure, axial globe length, pre and post operative visual acuity, complications rates during and after anesthesia and surgery. No changes in the anticoagulant regimen were made prior to surgery. We divided patients into 7 groups: group 1: patients with no anticoagulants used as the control group; group 2: patients treated with anticoagulant therapy (warfarin, fluindone, acenocoumarol); group 3: patients treated with aspirin; group 4: patients treated with clopidogrel therapy; group 5: patients treated with both anticoagulant and aspirin medications; group 6: patients treated with both anticoagulant and clopidogrel medications; group 7: patients treated with both aspirin and clopidogrel medications. Results: 239 eyes (206 patients) were included: 168 eyes without any anticoagulant medication (70.3%) and 71 eyes with anticoagulant and/or antiplatelet agents (29.7%): group 1 n=168 eyes; group 2 n=13 eyes (5.4%); group 3 n=35 eyes (14.7%); group 4 n=12 eyes (5%); group 5 n=4 eyes (1.7%); group 6 n=2 eyes (0.8%); group 7 n=5 eyes (2.1%). Patient ages ranged from 21 to 96 years (mean, 67±13.7 years). Mean follow-up was 3.1±2.5 months. Mean final visual acuity after surgery increased from 1.20±0.9 to 0.88±0.83 LogMAR. No surgery was post-poned or cancelled due to an anesthetic complication. Peroperatively, only 3 procedures were complicated. The incidence of postoperative hemorrhagic complications was increased in patients taking anticoagulant and/or antiplatelet medications (P<0.001) vs non-users. More especially the incidence of bleeding complications was increased in group 4 (n=6/12) and 7 (n=3/5) vs non-users (n=16/168) (P<0.001). Conclusions: Peribulbar anesthesia for vitreoretinal surgery can be safely performed in patients receiving anticoagulant and/or antiplatelet agents. Those medications are associated with a significant increase in minor operative hemorrhagic complications, which resolved spontaneously without persistent visual sequelae or the need for additional surgery.