Ophthalmic patients on antithrombotic drugs: a review and guide to perioperative management

Kl, Kong; Khan, Javaid Arif

doi:10.1136/bjophthalmol-2014-306036

Cited by 37 publications

(22 citation statements)

References 56 publications

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“…With ageing population, the number of patients using anticoagulant/ antiplatelet treatment has increased in recent years worldwide (Grzybowski et al 2015;Kong & Khan 2015). Concomitant use of novel oral anticoagulants (clopidogrel) or old warfarin and statin is common in the secondary prevention of cardiovascular events, representing 4.9% of study eyes in our VR surgical cohort.…”

Section: Discussionmentioning

confidence: 99%

Statin use and vitreoretinal surgery: Findings from a Finnish population‐based cohort study

Loukovaara

Sahanne

Takala

et al. 2018

Acta Ophthalmologica

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Section: Discussionmentioning

confidence: 99%

Statin use and vitreoretinal surgery: Findings from a Finnish population‐based cohort study

Loukovaara

Sahanne

Takala

et al. 2018

Acta Ophthalmologica

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“…A comprehensive guide to perioperative management of such patients has been published previously. 35 The treatment of uremic platelet dysfunction is discussed below in the section discussing alternatives to platelet transfusion.…”

Section: Qualitative Platelet Dysfunction and Proceduresmentioning

confidence: 99%

Perioperative thrombocytopenia: evidence, evaluation, and emerging therapies

Nagrebetsky

Al‐Samkari

Davis

et al. 2019

British Journal of Anaesthesia

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Thrombocytopenia is a common perioperative clinical problem. While global haemostasis is influenced by many patientand procedure-related factors, the contribution of thrombocytopenia to bleeding risk is difficult to predict, as platelet count does not linearly correlate with likelihood of bleeding. Thus, the widely used definition of thrombocytopenia and grading of its severity have limited clinical utility. We present a summary and analysis of the current recommendations for invasive procedures in thrombocytopenic patients, although the platelet count at which any given procedure may safely proceed is unknown. The benefits and risks of preoperative platelet transfusions should be assessed on a patientby-patient basis, and alternatives to platelet transfusion should be considered. In non-emergent surgeries or in postoperative thrombocytopenic patients, haematology consultation should be considered to guide diagnostics and management. We present a pragmatic approach to the evaluation of perioperative thrombocytopenia. Editor's key pointsMost 'threshold' recommendations for preprocedural platelet transfusions are based on low quality evidence or opinion. Existing data suggest no linear relationship between platelet count and risk of spontaneous bleeding. Given the risks associated with platelet transfusion, alternatives should be considered: desmopressin and antifibrinolytic agents in the acute setting and thrombopoietin receptor agonists for select groups in the elective setting. Thrombopoietin receptor agonists effectively increase platelet count in thrombocytopenic patients, but are currently off-label except in patients with thrombocytopenia as a result of chronic liver disease.

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“…Previous reviews generally advocated continuation of anticoagulants and antiplatelet agents during ophthalmic anesthesia, on the grounds that it conferred an increased risk only for minor bleeding [ 1 , 7 ]. However, these reviews did not evaluate the methodology and risk of bias of the original studies, thereby limiting the validity of the conclusions [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Risk of Hemorrhage during Needle-Based Ophthalmic Regional Anesthesia in Patients Taking Antithrombotics: A Systematic Review

et al. 2016

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BackgroundPatients undergoing ophthalmic surgery are usually elderly and, due to systemic disease, may be on long-term therapy, such as antithrombotic agents. Rates of hemorrhagic complications associated with invasive procedures may be increased by the use of anticoagulants and antiplatelet agents.ObjectiveTo compare the incidence of hemorrhagic complications in patients undergoing needle-based ophthalmic regional anesthesia between patients on antithrombotic therapy and those not on such therapy.MethodsA systematic review was conducted by two independent reviewers based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the “gray” literature (Google Scholar). The end search date was May 8, 2015, across all databases.ResultsFive studies met the eligibility criteria. In three studies, individual risk of bias was low, and in two of them, moderate. In all studies, no differences regarding mild to moderate incidence of hemorrhagic complications were found between patients using antithrombotics (aspirin, clopidogrel, and warfarin) and those not using them. Rates of severe hemorrhagic complication were very low (0.04%) in both groups, supporting the safety of needle blocks, even in patients using antithrombotics. High heterogeneity across studies prevented meta-analysis. Limitations to these results include low statistical power in three experimental studies and a large 95% confidence interval in the two retrospective cohorts.ConclusionIn this review, none of the selected studies showed significant bleeding related to needle-based ophthalmic regional anesthesia in association with the use of aspirin, clopidogrel, or vitamin K inhibitors. Since the available data is not powerful enough to provide a reliable evaluation of the true effect of antithrombotics in this setting, new studies to address these limitations are necessary.

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Ophthalmic patients on antithrombotic drugs: a review and guide to perioperative management

Cited by 37 publications

References 56 publications

Statin use and vitreoretinal surgery: Findings from a Finnish population‐based cohort study

Statin use and vitreoretinal surgery: Findings from a Finnish population‐based cohort study

Perioperative thrombocytopenia: evidence, evaluation, and emerging therapies

Risk of Hemorrhage during Needle-Based Ophthalmic Regional Anesthesia in Patients Taking Antithrombotics: A Systematic Review

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