Maintenance of Anticoagulant and Antiplatelet Agents for Patients Undergoing Peribulbar Anesthesia and Vitreoretinal Surgery

Abstract

Peribulbar anesthesia for vitreoretinal surgery can probably be performed safely in patients receiving anticoagulants. However, retinal surgeons should be aware that severe bleeding complications are more frequent in patients receiving antiplatelet therapy.

Comment gérer les antithrombotiques en chirurgie vitréorétinienne ?

“…De même, Kallio et al [33] n'ont pas significativement retrouvé d'hémorragie compliquant l'anesthésie rétro ou péribulbaire dans leur série de 76 cas sous warfarine arrêtée 2 jours avant la date de la chirurgie (série de1383 patients consécutifs sous antithrombotiques). L'étude plus récente de l'équipe de C. Creuzot-Garcher au CHU de Dijon conforte également la possibilité de réaliser une anesthésie loco-régionale sous AC ou AAP [34].…”

Perioperative Management of Antithrombotic Medications in Vitreoretinal Surgery

“…Of these, only 3 of 44 antiplatelet patients (6.8%) developed long-term sight-threatening hemorrhagic complications including submacular hemorrhage in 3 of 44 (6.8%, all on clopidogrel) 45. Of these 64 procedures, 30 of these cases (47%) were associated with a therapeutic INRZ1.5.…”

To bleed or clot?

“…However, even among these studies there is disagreement. Some show a higher rate of serious ocular haemorrhage in patients taking antiplatelet agents but not anticoagulants, although others show the inverse finding …”

“…Most studies demonstrate no increase in serious ocular bleeding in patients maintained on antiplatelet or anticoagulant therapy. [1][2][3][4][5][6][7][8][9][10][11] Others suggest a higher rate of haemorrhagic complications and/or surgical failure 12 in the context of glaucoma 12,13 or vitreoretinal 14,15 surgery. However, even among these studies there is disagreement.…”