Preoperative management of ophthalmic patients taking oral anticoagulants

Abstract

Surgical treatment is often accompanied by such complication as bleeding, and ophthalmic surgery is not an exception. The bleeding risk depends on many factors, the most significant are age, arterial hypertension, hepatic and renal impairment, prior stroke or treatment with oral anticoagulants.The aim. To evaluate the structure of patients taking novel oral anticoagulants (NOACs) with an assessment of activated partial thromboplastin time before ophthalmosurgical treatment.Materials and methods. 54 patients taking oral anticoagulants were included in the study. A retrospective analysis of medical histories of patients who had surgery for ocular pathology was carried out. The patients were divided into two groups: group 1 – 28 patients whose activated partial thromboplastin time (APTT) did not exceed 45 seconds; group 2 – 26 patients with APTT more than 45 seconds. The criterion for the numerical expression of APTT is the safety of performing regional anesthesia against the background of taking anticoagulant drugs. Statistical processing was performed using the Mann – Whitney test (p < 0.05).Results. A comparative analysis of the results showed that the patients of the group 2 had higher rates of APTT. At the same time, they were less likely to have acute cerebrovascular accident (11.5 % compared to 21 % of patients in the group 2) and prior acute myocardial infarction (19 % and 28 %, respectively). Among all the patients, women and slightly older patients prevailed.Conclusion. Patients with atrial fibrillation make up the majority of patients undergoing ophthalmosurgical treatment and taking NOACs. Surgical treatment method was phacoemulsification with intraocular lens implantation. Studying APTT before the surgery allowed us to identify a category of patients with high APTT, to prescribe the withdrawal of the drug before the surgery in order to create optimal conditions for surgical treatment.