The effect of aspirin and warfarin therapy in trabeculectomy

Abstract

Aim The management of patients on antiplatelet and anticoagulation therapy (APACT) in glaucoma surgery currently has no specific recommendations. We aimed to establish the risk of haemorrhagic complications and surgical outcome in patients on APACT in glaucoma surgery. Methods We retrospectively examined 367 consecutive trabeculectomies performed between 1994 and 1998. Preoperatively 60 (16.4%) patients were on APACT (55 on aspirin and five on warfarin). The incidence of hyphaema and haemorrhagic complications between patients with and without APACT was documented. Surgical success was defined in two categories as an intraocular pressure (IOP) o21 mmHg and an IOP o16 mmHg 2 years following trabeculectomy with and without antiglaucoma medication. Results None of the patients on aspirin suffered significant intra or postoperative haemorrhage. Aspirin was associated with a significantly higher risk of hyphaema (P ¼ 0.0015) but this was not found to significantly affect IOP control at 2 years. Patients on warfarin suffered haemorrhagic complications and trabeculectomy failure. Conclusions Aspirin appears to be safe to continue with during trabeculectomy. Patients on aspirin have an increased risk of hyphaema following trabeculectomy. This however does not appear to affect surgical outcome. Warfarinised patients are at risk of serious bleeding complications. They require careful monitoring pre-and postoperatively and are at risk of trabeculectomy failure.

Perioperative management of anticoagulant users scheduled for glaucoma surgery: a survey among the Brazilian Glaucoma Society members

“…The later seem to be even more important in these cases, as approximately half of the BGS members interviewed reported some type of hemorrhagic compli cation (from subconjunctival hemorrhage to choroidal detachment). In this context, a previous report have alerted to the risk of excessive hemorrhage during glaucoma surgery in anticoagulated patients, es pecially in those taking warfarin (11) . The main drawback of our paper is its low response rate (13%) and number of participants (n=52), which should be considered while interpreting our results.…”

Anticoagulation therapy in glaucoma surgery

“…Cobb et al [9] in their retrospective multi-surgeon, multi-centre series of 367 consecutive patients undergoing mainly unaugmented trabeculectomy reported increased postoperative complications in patients continuing their anticoagulation therapy. Hyphema was the commonest complication, occurring in 55% of all patients on anticoagulation (100% of those on warfarin, 50.9% of those on aspirin) and 28% of those not on anticoagulation.…”

“…In ophthalmology, the approach of ophthalmologists to management of their patients on anticoagulation prior to surgery has been examined in at least one other subspecialty area [5], and complications associated with the use of anticoagulation-particularly warfarin-have been highlighted in cataract [6,7], vitreoretinal [8] and glaucoma surgery [9]. In glaucoma, it has been shown that patients undergoing trabeculectomy are more likely to be on some form of anticoagulation therapy than those controlled on drops alone [10].…”

Antikoaguliantų Ir Antiagregantų Vartojimas Akių Chirurgijoje

“…Tokios komplikacijos dažniau pasitaiko pacientams, vartojantiems antikoaguliantų ar antiagregantų preparatus [21]. Nustatyta, kad pacientams, vartojantiems varfariną, kraujavimo ar nesėkmingo gydymo rezultatai yra dažnesni [22]. Akyje implantuojami antiglaukominiai implantai, palaikantys reikiamo diametro fistulę, gali lemti hifemos atsiradimą ir suprachoroidinio kraujavimo riziką [23].…”

“…Tačiau vartojantiems aspiriną dažniau stebėta hifema, kuri neturėjo reikšmės pacientų akispūdžio kontroliavimui po 2 metų. Penkiems pacientams, vartojusiems varfariną, pasireiškė kraujavimo komplikacijos, o dviem reikėjo chirurginiu būdu pašalinti hifemą [22]. Antiglaukominė operacija yra viena iš kraštutinių priemonių, kai kiti glaukomos gydymo metodai neefektyvūs ar netoleruojami, todėl nuo jos sėkmės priklauso tolimesnis ligos progresavimas.…”