The team said it believed that it was important to stratify the ophthalmic surgeries depending on the risk of development of hemorrhagic complications during the perioperative period. They conducted a PubMed search from January 2007 to August 2017 to identify articles that provided recommendations on managing antithrombic agents during the perioperative period of ophthalmic surgeries and reviewed the incidence rates of the associated hemorrhagic complications.
The literature recommendations that all anti-thrombotic agents be continued for routine cataract surgeries performed under topical or sub-Tenon’s anesthesia. For sharp-needle anesthesia, the literature recommended that surgeons avoid dual antiplatelet therapy and patients could continue taking warfarin if the International Normalized Ratio (INR) was within the therapeutic range.
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For glaucoma surgery, the literature recommended that aspirin and clopidogrel be discontinued when the drugs are monotherapy for primary prevention, but they can be continued for secondary prevention of cardiovascular diseases. P2Y12 receptor inhibitors should be discontinued if used as dual antiplatelet therapy. However, the risks and benefits of continuation of antiplatelet agents need special consideration in neovascular glaucoma and high IOP.
“It is also important to consider and recognize that, intraoperative and post-operative haemorrhagic complications in glaucoma, especially if sustained or prolonged, can cause severe visual loss due to high pressure in already compromised optic nerves,” investigators wrote. “Anticoagulants should be discontinued with consideration for bridging therapy depending on patient’s risk factors.”
For vitreoretinal surgery, the literature results were considered controversial.
“The recommendations for perioperative management is similar to that for glaucoma surgery,” the investigators noted. “Anti-thrombotic agents are to be discontinued where possible and to be cautious of these agents in the presence of neovascular retinal diseases.”