Antiplatelet and anticoagulant agents in vitreoretinal surgery: a prospective multicenter study involving 804 patients

Meillon, Cyril; Gabrielle, Pierre‐Henry; Bron, A.; Garcher, Catherine Creuzot

doi:10.1007/s00417-018-4152-0

Cited by 9 publications

(5 citation statements)

References 5 publications

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“…Even though some authors have found an increased risk of haemorrhagic complications in anticoagulated patients undergoing PPV, the incidence has been low, without statistical significance, and without serious consequences for visual acuity [9–11, 20, 21]. Dayani and Grand analysed 54 patients who underwent PPV while taking warfarin and found four patients who suffered postoperative vitreous haemorrhage, all of which resolved spontaneously requiring no further surgery [9].…”

Section: Discussionmentioning

confidence: 99%

“…Grand and Walia studied 36 eyes of 33 patients who underwent PPV while being treated with novel anticoagulant therapy and reported that four eyes (11.1%) experienced postoperative vitreous haemorrhage after which two eyes (5.5%) required repeat surgical intervention and two eyes (5.5%) cleared spontaneously [10]. Meillon et al [11] and Oh et al [20] report 6.6% and 7% of haemorrhagic complications, respectively, after PPV in patients undergoing anticoagulation therapy, in both studies without visual consequences in the long term. Narendran and Williamson report one case of postoperative choroidal haemorrhage, but only 7 of the 541 patients in their study were taking warfarin during PPV [21].…”

Section: Discussionmentioning

confidence: 99%

“…So far, no trial has compared the perioperative complications and visual results associated with continuation or interruption of oral anticoagulant therapy before PPV under retrobulbar anaesthesia in a prospective and randomised manner. There is only one study that has evaluated this issue in a prospective but nonrandomised manner, but the authors included a small number of patients, did not standardise the management of anticoagulant agents in the perioperative period and did not record all haemorrhagic complications [11]. Moreover, there is only one study that has evaluated haemorrhagic intraoperative complications associated with PPV in patients under treatment with novel anticoagulant therapy [10].…”

Section: Introductionmentioning

confidence: 99%

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Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events

Andonegui

Capdevila

Zubicoa

et al. 2019

Trials

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BackgroundVitreoretinal surgery in anticoagulated patients is a challenging situation for vitreoretinal surgeons, who have to choose between being faced with the systemic thromboembolic risks that the interruption of anticoagulation involves, or the intra- and postoperative haemorrhagic risks associated with maintenance of this therapy. So far, no trial has compared, in a prospective and randomized manner, perioperative complications and the visual results associated with continuation or interruption of oral anticoagulant therapy before pars plana vitrectomy (PPV) under retrobulbar anaesthesia. The main objective of this trial is to compare haemostasis-related perioperative complications of PPV in patients maintaining anticoagulant therapy before surgery compared to patients with an interruption in this therapy before surgery.MethodsNinety-six patients will be randomly assigned to either the control group, in whom oral anticoagulant therapy will be interrupted and substituted with subcutaneous heparin according to local clinical practice, or the intervention group in whom oral anticoagulant therapy will not be interrupted before surgery. Patients will be stratified according to the oral anticoagulant they were taking (direct or indirect anticoagulation). They will be followed up for 12 weeks, and the primary outcome, and haemorrhagic complications until 15 days after surgery, will be evaluated.DiscussionThis trial will provide novel information on the possibility of continuing anticoagulant therapy during PPV. The benefits expected from the change in the current surgical management paradigm for anticoagulated patients would be a decreased risk in the incidence of perioperative thromboembolic events and the possibility of performing surgery without delay and without the need for patients to change their usual anticoagulation protocol to the more complex and less safe substitutive therapy.Trial registrationClinical Trials Register EudraCT, 2018–000753-45. Registered on 11 November 2018.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events

Andonegui

Capdevila

Zubicoa

et al. 2019

Trials

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“…The effect of anticoagulation on surgical outcomes has been studied in cataract, vitreoretinal, oculoplastics, and glaucoma surgeries, [13][14][15][16] but the effect on strabismus surgery has been little studied. Kemp…”

Section: Potential Hemorrhagic Complications Of Strabismus Surgerymentioning

confidence: 99%

Anticoagulation: a practical guide for strabismus surgeons

Robbins

Wang

Frazer

et al. 2019

Journal of American Association for Pediatric Ophthalmology and

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An increasing number of surgical strabismus patients are taking oral anticoagulant and antiplatelet agents, with more diverse mechanisms of action than those used in the past. The decision as to whether to continue these drugs throughout the perioperative period is difficult and must be based on the balance between hemorrhagic and thrombotic risk. To help guide strabismus surgeons with clinical management in these cases, we review potential hemorrhagic complications of strabismus surgery and examine the use of anticoagulant and antiplatelet drugs during the perioperative period. Surgical strategies that might help minimize intraoperative hemorrhage in patients on anticoagulant therapy are also discussed.

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“…Dane z brytyjskiej bazy BEAVRS pokazały, że wśród witrektomii wykonanych z powodu otworu w plamce 67,7% stanowiły zabiegi fakowitrektomii [14]. Z kolei we Francji w latach 2005-2014 zabiegi łączone stanowiły 15,8% witrektomii [15]. W Stanach Zjednoczonych Ameryki odsetek operacji łączonych może być mniejszy [12].…”

Section: Wady Fakowitrektomiiunclassified

Cataract formation as a complication of vitrectomy

Kanclerz¹

2018

OphthaTherapy

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Antiplatelet and anticoagulant agents in vitreoretinal surgery: a prospective multicenter study involving 804 patients

Cited by 9 publications

References 5 publications

Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events

Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events

Anticoagulation: a practical guide for strabismus surgeons

Cataract formation as a complication of vitrectomy

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