Maintenance of anticoagulant and antiplatelet agents for patients undergoing vitreoretinal surgery

Abstract

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. 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. No changes in the anticoagulant regimen were made prior to surgery. We divided patients into 7 groups: group 1: patients with no anticoagulants and 6 groups defined according to the type of anticoagulant or antiplatelet medication. 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%). Only 3 cases of long‐term sight‐threatening hemorrhagic complications (4.2%) were noted: 2 from patients with pseudo‐tumoral form of age‐related macular degeneration associated with vitreous hemorrhage, and 1 from patient with tractionnal retinal detachment secondary to complicated diabetic retinopathy. No surgery was post‐poned or cancelled due to an anesthetic complication.The incidence of postoperative hemorrhagic complications was increased in patients taking anticoagulant and/or antiplatelet medications (P=0.001) vs non‐users. Conclusion Peribulbar anesthesia for vitreoretinal surgery can be safely performed in patients receiving anticoagulant and/or antiplatelet agents.