Comparative Incidence of Postoperative Hemorrhage in Vitreoretinal Surgery in Patients on Anti-Coagulants

Starr, Matthew R.; Ammar, Michael; Patel, Luv; Boucher, Nicholas; Yonekawa, Yoshihiro; Hsu, Jason C.; Ho, Allen C.; Regillo, Carl D.; Chiang, Allen

doi:10.3928/23258160-20210628-03

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…Grand et al [ 21 ] were the first to show that patients may successfully undergo vitreoretinal surgery while maintaining medications, such as rivaroxaban, apixaban, dabigatran, and prasugrel. The same results on the safety of not stopping NOAs were demonstrated afterward by various authors [ 13 , 14 , 19 ].…”

Section: Discussionsupporting

confidence: 80%

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Antiplatelets and Anticoagulants in Vitreoretinal Surgery: A Systematic Review

Ferraro

Maria

et al. 2023

Life

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Background: Antiplatelets and anticoagulants have substantially influenced contemporary vitreoretinal surgical practices. The availability of new oral blood thinners has recently spurred a renewed interest in the clinical approach to vitreoretinal surgical conditions since it may be difficult for the surgeon to collect sufficient evidence-based data to decide whether to discontinue or continue such medications. Materials and Methods: We conducted a systematic review on the use of antiplatelets and/or anticoagulants in the perioperative setting in vitreoretinal surgery and their possible complications, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level of evidence, according to the Oxford Centre for Evidence-Based Medicine (OCEM) 2011 guidelines, and the quality of evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, were assessed for all included articles. Results: In total, 2310 articles were initially extracted, out of which 1839 articles were obtained after duplicates were removed and their abstracts were screened. A total of 27 articles were included in the full-text review. Finally, a remaining 22 articles fulfilled the inclusion criteria. Conclusions: Even though there is just a small number of studies with solid results, the advantage of using antiplatelets and/or anticoagulants in vitreoretinal surgery seems to outweigh the disadvantages, which are mainly related to postoperative hemorrhagic complications.

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Section: Discussionsupporting

confidence: 80%

“…Starr et al [ 14 ], in 2021, gathered data on hemorrhagic complications in patients undergoing vitreoretinal surgery while being on NOAs or not taking any anticoagulants. To do so, the electronic health records of patients receiving PPV who did not have a history of ocular bleeding were analyzed across many centers over time.…”

Section: Resultsmentioning

confidence: 99%

Antiplatelets and Anticoagulants in Vitreoretinal Surgery: A Systematic Review

Ferraro

Maria

et al. 2023

Life

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“…Antiplatelet and anticoagulant usage has been associated with several types of intraocular bleeds, including vitreous and subretinal hemorrhages. 16 –19 Our study found that the IVI and PPV groups used significantly more anticoagulants than the observation group. This finding suggests that patients on antiplatelets and/or anticoagulants were more likely to experience RAM with VH and may need further interventions rather than observation alone.…”

Section: Discussionmentioning

confidence: 66%

Clinical Outcomes of Retinal Arterial Macroaneurysms With Vitreous Hemorrhage Treated With Observation, Antivascular Endothelial Growth Factor Intravitreal Injections, or Pars Plana Vitrectomy

Lam,

Shahlaee,

Salabati

et al. 2023

Journal of VitreoRetinal Diseases

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Purpose: To evaluate the clinical outcomes of different types of treatment of retinal arterial macroaneurysm with vitreous hemorrhage. Methods: This retrospective cohort study comprised patients with retinal arterial macroaneurysm and vitreous hemorrhage who were examined at a single retina clinic between 2013 and 2021. Results: Treatment arms included observation (n = 33), intravitreal injections (IVI) of antivascular endothelial growth factor agents (n = 5), and pars plana vitrectomy (PPV; n = 12). Baseline characteristics and final best-corrected visual acuity (BCVA) were similar in a combined analysis of all treatment groups ( P > .05). BCVA improved in all eyes, but the IVI and PPV arms had worse presenting BCVA. The mean number of injections was 3.6 ± 2.8. The incidence of subretinal hemorrhage was 18.2% in the observation arm, 25.0% in the PPV group (8.3% had subretinal tissue plasminogen activator), and 60.0% in the IVI group. The mean time to intervention was 13 ± 15.3 days for PPV and 38 ± 69.9 days for IVI. There was no correlation between the number of injections and final BCVA ( r = 0.13, P = .830). The IVI and PPV arms were more frequently on anticoagulants ( P = .011). There was no difference in final BCVA between those using anticoagulants (0.52 ± 0.53) vs not using anticoagulants (0.55 ± 0.65; P = .870). Conclusions: Most patients, regardless of treatment modality, demonstrated significantly improved BCVA and similar final visual outcomes. Patients with worse presenting BCVA were more likely to undergo PPV or IVI whereas those with better presenting BCVA had excellent outcomes with observation alone. Improved BCVA was not associated with the number of IVIs or anticoagulant use.

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Variation in Perioperative Care Practices Among Vitreoretinal Surgeons in the United States

Finn¹,

Talcott²,

Han³

et al. 2022

Ophthalmic Surg Lasers Imaging Retina

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Objective: To describe perioperative practice patterns among retinal surgeons managing retinal detachment (RD) repair. Methods: This was a cross-sectional pilot survey of vitreoretinal surgeons in the United States (US), identified by a previously published web-based search and cross-referencing names from the American Society of Retina Specialists. Self-reported peri-operative practices and subgroups were analyzed. Results: Of the 298 surgical retina specialists who completed the survey, 115 (39%) were in practice for ≤ 5 years, 102 (34%) were in practice for 6 to 20 years, and 81 (27%) were in practice for > 20 years; 60%, 23%, and 16% were in private, academic, and hybrid practice, respectively. Fifty-nine percent reported operating with trainees. For ocular blocks, 59% perform retrobulbar, 21% peribulbar, and 20% subtenon's (ST). Use of ST block varied significantly by years in practice and presence of trainees ( P < 0.0001, P = 0.004, respectively). Sixty percent perform primary scleral buckles (SB), 55% combined SB/pars plana vitrectomy (PPV), and 11% primary PPVs under general anesthesia. Use of general anesthesia for primary SB varied significantly by years in practice ( P = 0.007). Surgeons with fewer years in practice were more likely to recommend facedown positioning for macula-off RDs ( P < 0.0001). Forty-six percent of surgeons do not advise stopping blood thinners before surgery and this varied significantly by years in practice ( P = 0.006). Conclusions: Variation exists among US vitreoretinal surgeons in relation to anesthesia, postoperative positioning, and blood thinners restrictions. Preferences are influenced by years in practice and less by trainees and practice setting. These results serve as a basis for larger, targeted US-based surveys on perioperative care and correlation with surgical outcomes. [ Ophthalmic Surg Lasers Imaging Retina 2022;53:681–690.]

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Comparative Incidence of Postoperative Hemorrhage in Vitreoretinal Surgery in Patients on Anti-Coagulants

Cited by 3 publications

References 30 publications

Antiplatelets and Anticoagulants in Vitreoretinal Surgery: A Systematic Review

Antiplatelets and Anticoagulants in Vitreoretinal Surgery: A Systematic Review

Clinical Outcomes of Retinal Arterial Macroaneurysms With Vitreous Hemorrhage Treated With Observation, Antivascular Endothelial Growth Factor Intravitreal Injections, or Pars Plana Vitrectomy

Variation in Perioperative Care Practices Among Vitreoretinal Surgeons in the United States

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