PERI-OPERATIVE MANAGEMENT OF OPHTHALMIC PATIENTS TAKING ANTI-THROMBOTIC THERAPY

Gregory Lip (1)

1 University Department of Medicine

Background. Increasing number of patients presenting for ophthalmic surgery are using oral anti-coagulant and anti-platelet therapy. The current practice of discontinuing these drugs pre-operatively due to a presumed increased risk of bleeding may not be evidence-based and could pose a significant risk to the patient's health. Objective. To provide an evidence-based review on the peri-operative management of ophthalmic patients that are taking anti-thrombotic therapy. In addition, we briefly discuss the underlying conditions that necessitate the use of these drugs, as well as management of the operative field in anti-coagulated patients. Methods. A systematic review of literature was performed. The databases searched included MEDLINE, EMBASE, database of abstracts of reviews of effects (DARE), Cochrane controlled trial register and Cochrane systematic reviews. In addition, the bibliographies of the included papers were also scanned for evidence. Results The available evidence suggests that aspirin did not appear to increase the risk of serious post-operative bleeding in any type of ophthalmic surgery. Topical, sub-tenon, peri-bulbar and retrobulbar anesthesia appear to be safe in patients on anti-thrombotic (warfarin and aspirin) therapy. Warfarin does not increase the risk of significant bleeding in most types of ophthalmic surgery when the INR was within the therapeutic range. Conclusion. Current data supports the continued use of aspirin and with some exceptions, warfarin in the peri-operative period. The risk of thrombosis-related complications on disruption of anticoagulation may be higher than the risk of significant bleeding by continuing its use for most types of ophthalmic surgery.

Mots clés: Medicine

Gregory Lip. PERI-OPERATIVE MANAGEMENT OF OPHTHALMIC PATIENTS TAKING ANTI-THROMBOTIC THERAPY. International Journal of Clinical Practice, 2011, 65 (3), pp.361. ⟨10.1111/j.1742-1241.2010.02538.x⟩. ⟨hal-00614654⟩