It can be important to stratify the ophthalmic surgeries depending on the risk of development of hemorrhagic complications during the perioperative period.
Patients who undergo ophthalmic surgery are often concomitantly taking antithrombotic drugs, i.e., antiplatelets and anticoagulants, during the perioperative period may require different management than patients not taking those drugs. Investigators at St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, UK, surveyed ophthalmologists regarding this scenario and reported that most physicians were comfortable with managing patients taking antiplatelets. However, the survey indicated that the situation was not so clear-cut when patients were taking warfarin and direct oral anticoagulants (DOACs).
Achini K. Makuloluwa, MD, NHS Greater Glasgow and Clyde, and his research team reported that there was variability in managing patients on warfarin and DOACs.1 A startling finding was that “40% (of ophthalmologists) were unaware of existing guidelines” for managing these patients, according to the survey. The researchers also found that within the aging population, more patients are taking these drugs to prevent and treat cardiovascular and ischemic cerebral disease.
“Continuing antithrombotic agents perioperatively may increase the risk of potentially sight-threatening haemorrhagic complications, whereas discontinuing these medications may increase the risk of life-threatening thromboembolic events,” the researchers noted. “Therefore, it is important to understand the indications of antithrombotic agents and when it may be safe to discontinue them peri-operatively.”
Researchers also pointed out that it was important to stratify the ophthalmic surgeries depending on the risk of development of hemorrhagic complications during the perioperative period. Based on these concerns, 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 research team also reviewed all guidelines in the UK from the Royal College of Ophthalmologists and British Society of Haematology.
1. A.K. Makuloluwa, S, Tiew, M. Briggs, Peri-operative management of ophthalmic patients on antithrombotic agents: a literature review, Eye 2019; 1044-1059