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Confalonieri F, Ferraro V, Di Maria A, Gaeta A, Vallejo-Garcia JL, Vinciguerra P, Lumi X, Petrovski G. Antiplatelets and Anticoagulants in Vitreoretinal Surgery: A Systematic Review. Life (Basel) 2023; 13:1362. [PMID: 37374144 DOI: 10.3390/life13061362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
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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Affiliation(s)
- Filippo Confalonieri
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
| | - Vanessa Ferraro
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Alessandra Di Maria
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Alessandro Gaeta
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Josè Luis Vallejo-Garcia
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Paolo Vinciguerra
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Xhevat Lumi
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
- Eye Hospital, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000 Split, Croatia
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Lauermann P, Klingelhöfer A, Mielke D, Bahlmann D, Hoerauf H, Koscielny J, Sucker C, Feltgen N, van Oterendorp C. Risk Factors for Severe Bleeding Complications in Glaucoma Surgery and the Role of Antiplatelet or Anticoagulant Agents. Clin Ophthalmol 2022; 16:1245-1254. [PMID: 35493972 PMCID: PMC9041781 DOI: 10.2147/opth.s361867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the influences and risk factors for severe bleeding complications during glaucoma surgery, and to investigate the role of antiplatelet (AP) and anticoagulant (AC) agents. Methods This prospective study enrolled patients undergoing trabeculectomy, trabeculotomy (with Trabectome® or Kahook Dual Blade®), viscocanaloplasty and Ahmed or Baerveldt implants. Bleeding severity was graded on an ordinal scale ranging from 0 to 5. Immediately after surgery and one day later, the incidence and severity of bleeding events was documented on a standardized form. A grade ≥3 was defined as severe bleeding. The influence of known systemic disorders, the type of anesthesia, surgical procedure, intraoperative blood pressure, and the use of or change in AP or AC agents on intraoperative bleeding were analyzed. Results Data from 89 eyes undergoing glaucoma procedures were included (age 71.3y ± 10.5). We observed severe intraoperative bleeding in 8 eyes (9%) and found that concomitant diseases such as the history of a deep vein thrombosis or peripheral arterial occlusive disease, and the type of surgical procedure (trabeculectomy and viscocanaloplasty) were significantly associated with severe bleeding events. By contrast, the use of AP/ AC agents had no significant influence on severe intraoperative bleeding events. Conclusion According to the results of our study cohort, glaucoma procedures entailing scleral manipulations (trabeculectomy and viscocanaloplasty) and concomitant diseases such as the history of a deep vein thrombosis or peripheral arterial occlusive disease influence the risk of severe intraoperative bleeding events, we detected no increased risk related to concomitant antiplatelet and/ or anticoagulant medication use.
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Affiliation(s)
- Peer Lauermann
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
- Correspondence: Peer Lauermann, Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch Str. 40, Goettingen, 37075, Germany, Email
| | - Anthea Klingelhöfer
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany
| | - Dirk Bahlmann
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - Hans Hoerauf
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - Juergen Koscielny
- Gerinnungsambulanz mit Hämophiliezentrum im Ambulanten Gesundheitszentrum (AGZ), Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
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Kishore K, Hariprasad SM, Mungee S. Perioperative Antiplatelet Agents and Anticoagulants in Vitreoretinal Surgery. Ophthalmic Surg Lasers Imaging Retina 2022; 53:71-78. [PMID: 35148217 DOI: 10.3928/23258160-20220128-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Guise PA, Wang K. Haemorrhagic complications following cataract and vitreoretinal surgery with sub-Tenon's block in patients receiving non-vitamin K oral anticoagulant agents: A prospective audit. Anaesth Intensive Care 2022; 50:289-294. [PMID: 35078342 DOI: 10.1177/0310057x211057136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
There is a lack of data to support either continuation or interruption of non-vitamin K oral anticoagulants for cataract and vitreoretinal surgery. A prospective audit was undertaken of 291 patients undergoing cataract surgery or vitreoretinal surgery, predominantly under sub-Tenon's block, while continuing these agents. The median time from last non-vitamin K oral anticoagulant dose to the insertion of sub-Tenon's block was five hours. No patient required emergency reversal of anticoagulation. There were no sight-threatening complications in the immediate perioperative period, although two vitreoretinal patients (3.8%) had a moderate haemorrhagic complication on day five, and two cataract patients (0.8%) had a minor haemorrhagic complication on days one and 14 postoperatively. Despite continuing their non-vitamin K oral anticoagulants, three (1%) cataract patients had a moderate thromboembolic complication within the 30-day postoperative period. The risk of haemorrhagic complications associated with continuation of anticoagulation with non-vitamin K oral anticoagulants for cataract and vitreoretinal surgery is low, and this audit supports the continuation of non-vitamin K oral anticoagulants for our patients having cataract and vitreoretinal surgery.
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Affiliation(s)
- Philip A Guise
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Kailun Wang
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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5
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Lauermann P, Klingelhöfer A, Mielke D, van Oterendorp C, Hoerauf H, Striebe NA, Storch MW, Pfeiffer S, Koscielny J, Sucker C, Bemme S, Feltgen N. Risk Factors for Severe Bleeding Complications in Vitreoretinal Surgery and the Role of Antiplatelet or Anticoagulant Agents. Ophthalmol Retina 2021; 5:e23-e29. [PMID: 33915331 DOI: 10.1016/j.oret.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To evaluate the influences and risk factors for severe bleeding complications during vitreoretinal surgery and to investigate the role of antiplatelet and anticoagulant agents. DESIGN Prospective trial. PARTICIPANTS Patients undergoing vitreoretinal surgery. METHODS The procedures included were pars plana vitrectomy and scleral buckling. We developed a uniform classification to grade the bleeding severity. Bleeding was graded on an ordinal scale ranging from 0 to 5. Immediately after surgery and 1 day later, the incidence and the severity of bleeding events was documented on a standardized form. A grade of 3 or more was defined as severe bleeding. Furthermore, the influence of known systemic disorders before surgery, the type of anesthesia, type of surgical procedure, intraoperative blood pressure, and the use or change of antiplatelet or anticoagulant agents on intraoperative bleeding was analyzed. MAIN OUTCOME MEASURES Incidence and risk factors for severe intraoperative bleeding events. RESULTS Data from 374 eyes undergoing vitreoretinal procedures were included in our study (mean age, 67.6 ± 12.9 years). A severe intraoperative bleeding event was observed in 15 eyes (4%). We found that concomitant diseases such as diabetes mellitus and carotid artery stenosis, the presence of diabetic retinopathy, younger age, and scleral buckling combined with a transscleral puncture were associated significantly with severe bleeding events. By contrast, use of antiplatelet or anticoagulant agents, or both, had no significant influence on severe intraoperative bleeding events. CONCLUSIONS Although external manipulations during buckling surgery (e.g., drainage of subretinal fluid) and concomitant diseases such as diabetes mellitus and carotid artery stenosis influences the risk of severe intraoperative bleeding events, we did not detect an increased risk related to coexisting antiplatelet or anticoagulant medication use, or both.
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Affiliation(s)
- Peer Lauermann
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany.
| | - Anthea Klingelhöfer
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | | | - Hans Hoerauf
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Nina-Antonia Striebe
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Marcus Werner Storch
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Sebastian Pfeiffer
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Juergen Koscielny
- Gerinnungsambulanz mit Hämophiliezentrum im Ambulanten Gesundheitszentrum (AGZ), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Sucker
- COAGUMED Coagulation Center, Berlin, Germany, and Medical School Brandenburg, Brandenburg an der Havel, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
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Starr MR, Ammar MJ, Patel LG, Boucher N, Yonekawa Y, Garg SJ, Hsu J, Ho AC, Regillo CD, Chiang A. Comparative Incidence of Postoperative Hemorrhage in Vitreoretinal Surgery in Patients on Anti-Coagulants. Ophthalmic Surg Lasers Imaging Retina 2021; 52:374-379. [PMID: 34309424 DOI: 10.3928/23258160-20210628-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Data regarding hemorrhagic complications of direct oral anticoagulants (DOACs) and vitreoretinal surgery are limited. PATIENTS AND METHODS Multicenter analysis of longitudinal, aggregated electronic health records of patients undergoing pars plana vitrectomy (PPV) with no prior history of ocular hemorrhage. Retrospective analysis of patients undergoing PPV between January 1, 2013, and December 31, 2019. The main outcomes were development of postoperative hemorrhagic complications within 1 month following vitreoretinal surgery. RESULTS A total of 58,131 eyes underwent PPV, with 2,956 (5.1%) on anticoagulant medication prior to surgery. Eight hundred twenty-eight eyes (1.4%) developed a postoperative hemorrhage. Of eyes with anticoagulation use, 50 of 2,956 (1.29%) developed a hemorrhage, whereas 778 of 55,175 (1.41%) of the eyes with no prior anticoagulation use developed a postoperative hemorrhage (P = .2107). CONCLUSION Use of DOACs prior to vitreoretinal surgery does not appear to be associated with increased rates of postoperative intraocular hemorrhage. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:374-379.].
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Update on the perioperative management of antiplatelets and anticoagulants in ophthalmic surgery. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:422-429. [PMID: 34340780 DOI: 10.1016/j.oftale.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Anti-thrombotic drugs (antiplatelets and anticoagulants) are widely used for different clinical reasons. This means that there are an increasing number of patients undergoing elective ophthalmic surgery that are being treated with these drugs. A better knowledge of their implications and their peri-operative use may help to prevent surgical and secondary adverse events. There is often no firm recommendation on how to manage certain drugs in certain surgeries. OBJECTIVE To review the recommendations in the scientific literature as regards managing anti-thrombotic agents during the peri-operative period of ophthalmic surgery. MATERIAL AND METHODS A review was made of the relevant guidelines and studies using an antiplatelet and anticoagulant drugs approach for cataract, vitreo-retinal, glaucoma, oculoplastic, and strabismus surgeries. RESULTS Recommendations about whether to continue or discontinue anti-thrombotic drugs in the peri-operative period of different ophthalmic surgical fields are presented. CONCLUSIONS There are only firm recommendations of maintaining anti-thrombotic drugs as regards cataract surgery using phacoemulsification with topical anaesthesia. In other surgical fields, ophthalmologists should balance the risk of thromboembolic events and risks of haemorrhagic complications in order to carry out a proper management. A multi-disciplinary approach is recommended for complex cases. Additional studies should be performed to better characterise the peri-operative use of anti-thrombotic agents in order to prepare clinical guidelines for ophthalmic surgery.
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8
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Gallice M, Rouberol F, Leynaud JL, Albaladejo P, Chiquet C. Prevalence of antithrombotic use in a vitreoretinal surgery cohort. J Fr Ophtalmol 2021; 44:e145-e147. [PMID: 33485689 DOI: 10.1016/j.jfo.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Gallice
- Service d'ophtalmologie, CHU de Grenoble, 38043 Grenoble cedex 09, France; Université Grenoble-Alpes, Grenoble, 38041 Grenoble, France
| | - F Rouberol
- Centre Kleber, 50, cours Franklin-Roosevelt, 69006 Lyon, France
| | - J-L Leynaud
- Centre Kleber, 50, cours Franklin-Roosevelt, 69006 Lyon, France
| | - P Albaladejo
- Université Grenoble-Alpes, Grenoble, 38041 Grenoble, France; Pôle anesthésie-réanimation, CHU de Grenoble, 38043 Grenoble cedex 09, France
| | - Ch Chiquet
- Service d'ophtalmologie, CHU de Grenoble, 38043 Grenoble cedex 09, France; Université Grenoble-Alpes, Grenoble, 38041 Grenoble, France.
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Herranz-Heras JC, Alcalde-Blanco L, Cañas-Zamarra I, Mencía-Gutiérrez E, Ferro-Osuna M, Pérez-Trigo S. Update on the perioperative management of antiplatelets and anticoagulants in ophthalmic surgery. ACTA ACUST UNITED AC 2020. [PMID: 33371998 DOI: 10.1016/j.oftal.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Anti-thrombotic drugs (antiplatelets and anticoagulants) are widely used for different clinical reasons. This means that there are an increasing number of patients undergoing elective ophthalmic surgery that are being treated with these drugs. A better knowledge of their implications and their peri-operative use may help to prevent surgical and secondary adverse events. There is often no firm recommendation on how to manage certain drugs in certain surgeries. OBJECTIVE To review the recommendations in the scientific literature as regards managing anti-thrombotic agents during the peri-operative period of ophthalmic surgery. MATERIAL AND METHODS A review was made of the relevant guidelines and studies using an antiplatelet and anticoagulant drugs approach for cataract, vitreo-retinal, glaucoma, oculoplastic, and strabismus surgeries. RESULTS Recommendations about whether to continue or discontinue anti-thrombotic drugs in the peri-operative period of different ophthalmic surgical fields are presented. CONCLUSIONS There are only firm recommendations of maintaining anti-thrombotic drugs as regards cataract surgery using phacoemulsification with topical anaesthesia. In other surgical fields, ophthalmologists should balance the risk of thromboembolic events and risks of haemorrhagic complications in order to carry out a proper management. A multi-disciplinary approach is recommended for complex cases. Additional studies should be performed to better characterise the peri-operative use of anti-thrombotic agents in order to prepare clinical guidelines for ophthalmic surgery.
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Affiliation(s)
- J C Herranz-Heras
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
| | - L Alcalde-Blanco
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - I Cañas-Zamarra
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - E Mencía-Gutiérrez
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - M Ferro-Osuna
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - S Pérez-Trigo
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
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Louison S, Gabrielle P, Soudry A, Meillon C, Blanc J, Béal G, Arsène S, Le Mer Y, Berrod J, Kodjikian L, Creuzot‐Garcher C. Perioperative risk of bleeding with antithrombotic agents in macular surgery: a national, prospective, multicentre study. Acta Ophthalmol 2020; 98:e991-e997. [PMID: 32279459 DOI: 10.1111/aos.14434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/15/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the risk of haemorrhagic complications in elective macular surgery between patients with no antithrombotic (AT) treatment (defined as patients with no history of AT therapy or who discontinued AT therapy) and patients who continued AT treatment during the surgery. METHODS E-case report forms were prospectively recorded in a database before vitreoretinal surgery and 1 month after. Data on patient characteristics, surgical techniques, haemorrhagic complications and antithrombotic status were collected. Patients with retinal detachment, proliferative diabetic retinopathy and previous retinal haemorrhage were excluded. RESULTS A total of 748 procedures (single procedure in one eye per patient) were performed between January and May 2019. Among them, 202 patients (27.0%) were treated with antithrombotic therapy at the time of surgery: 19.5% with antiplatelet agents (n = 146), 6.3% with anticoagulants (n = 47) including 3.2% (n = 24) patients treated with novel oral anticoagulants, 0.8% (n = 6) with anticoagulants and antiplatelet agents, and 0.4% (n = 3) with heparin. Overall, 92 patients (12.3%) developed one or more haemorrhagic complications, of which 63 (11.5%) and 29 (14.4%) were in the non-AT and AT group, respectively. The multivariate logistic regression model showed no difference between AT treatment groups regarding ocular bleeding complications (odds ratio [OR] 1.2, 95% confidence interval (CI) [0.7-2.2], p = 0.54). CONCLUSION No cases of uncontrolled or severe perioperative haemorrhage in patients continuing antithrombotic agents were reported in this selected population. For the majority of the patients taking antiplatelets or anticoagulants, these agents could be safely continued during macular surgery.
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Affiliation(s)
- Solenne Louison
- Department of Ophthalmology University Hospital Dijon France
| | - Pierre‐Henry Gabrielle
- Department of Ophthalmology University Hospital Dijon France
- Eye and Nutrition Research Group National Scientific Research Council (CNRS) National Institute of Agronomic Research (INRA) University of Burgundy Dijon France
| | - Agnès Soudry
- Department of Clinical Research and Investigation University Hospital Dijon France
| | - Cyril Meillon
- Department of Ophthalmology University Hospital Dijon France
| | - Julie Blanc
- Department of Ophthalmology University Hospital Dijon France
| | - Guillaume Béal
- Department of Anaesthesiology University Hospital Dijon France
| | - Sophie Arsène
- Department of Ophthalmology University Hospital Tours France
| | - Yannick Le Mer
- Department of Ophthalmology Rothschild Ophthalmologic Foundation Paris France
| | | | - Laurent Kodjikian
- Department of Ophthalmology Croix‐Rousse University Hospital Lyon France
| | - Catherine Creuzot‐Garcher
- Department of Ophthalmology University Hospital Dijon France
- Eye and Nutrition Research Group National Scientific Research Council (CNRS) National Institute of Agronomic Research (INRA) University of Burgundy Dijon France
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Shukla AG, Ramulu PY. Management of Anticoagulation and Antiplatelet Therapy in Glaucoma Surgery. J Glaucoma 2020; 29:732-741. [PMID: 32858723 DOI: 10.1097/ijg.0000000000001594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of antithrombotic therapy is rising as the population of older adults grows and novel agents with wider indications emerge. Likewise, surgical treatment of glaucoma may become increasingly common as the prevalence of glaucoma increases and innovative treatment options are developed. These trends highlight the need to understand how best to manage antithrombotic therapy in the context of glaucoma surgery. This review article describes current literature on antithrombotic therapy and perioperative thromboembolic risk evaluation based on individual factors. In addition, guidance is offered on the management of antithrombotic therapy in the setting of each type of glaucoma surgery, with an emphasis on a multidisciplinary approach involving the patients' treating physicians.
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Affiliation(s)
- Aakriti G Shukla
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
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12
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Andonegui J, Zubicoa A. Anticoagulants And Vitreoretinal Surgery. ACTA ACUST UNITED AC 2020; 95:365-366. [PMID: 32493636 DOI: 10.1016/j.oftal.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Affiliation(s)
- J Andonegui
- Servicio de Oftalmología, Complejo Hospitalario de Navarra, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España; Red Temática de Investigación Cooperativa en Oftalmología RD 12/0034 «Oftalred».
| | - A Zubicoa
- Servicio de Oftalmología, Complejo Hospitalario de Navarra, Pamplona, España
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13
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Efficacy and safety of non-vitamin K-antagonist oral anticoagulants for retinal vascular diseases in patients with atrial fibrillation: Korean cohort study. Sci Rep 2020; 10:4577. [PMID: 32165726 PMCID: PMC7067845 DOI: 10.1038/s41598-020-61609-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/26/2020] [Indexed: 11/30/2022] Open
Abstract
We investigated the prevalence of retinal vascular occlusion and intraocular bleeding and compare their risks in patients undergoing anticoagulant therapy, either with non-vitamin K-antagonist oral anticoagulants (NOAC) or warfarin. We performed a cohort study (January 2015 to April 2018) in 281,970 patients with nonvalvular atrial fibrillation (AF) using health claims in the nationwide database of the Health Insurance Review and Assessment service of Korea. A Cox-proportional hazard regression was used to calculate the hazard ratio (HR) for retinal vascular occlusion or intraocular bleeding. The HR of retinal vascular occlusion was estimated to 1.59 (95% confidence interval [CI], 1.35–1.86) for NOAC users compared to that with warfarin users. Among the various types of NOACs, all NOACs showed higher risk of retinal vascular occlusion than did warfarin. For intraocular bleeding, the HR was estimated to be 0.86 (95% CI, 0.75–0.98) for NOAC users compared with that with warfarin users. The risk of retinal vascular occlusion was higher in NOAC users than in warfarin users, while the risk of intraocular bleeding was lower with NOAC therapy. NOACs were not found to be as effective as warfarin for retinal vascular occlusion, but safe in terms of intraocular bleeding.
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Chen AF, He X, Nirwan RS, Sridhar J, Kuriyan AE. Perioperative Management of Anticoagulants in Ocular Surgeries. Int Ophthalmol Clin 2020; 60:3-15. [PMID: 32576719 PMCID: PMC7334869 DOI: 10.1097/iio.0000000000000316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Use of anticoagulant therapy has increased in patients presenting for ophthalmic surgery over the past decade. The decision of whether or not to discontinue anticoagulant medications prior to ophthalmic surgeries is nuanced and ultimately based on multiple factors including the type of surgery and the patient’s comorbidities and risk profile. In the setting of cataract surgery, no increased risk of bleeding with anticoagulation was observed in a large prospective study, which suggests that anticoagulation should not be interrupted for the average-risk patient on anticoagulation. In other types of ophthalmic surgery, expert opinion and studies are divided on the perioperative management of anticoagulant therapy. Preoperative thromboembolic risk stratification, intraoperative techniques to minimize bleeding, and postoperative management are also reviewed to generate more comprehensive recommendations on ophthalmic perioperative management of anticoagulation.
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Affiliation(s)
- Alexander F. Chen
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
| | - Xu He
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
| | - Rajinder S. Nirwan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Ajay E. Kuriyan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
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15
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Andonegui J, Capdevila F, Zubicoa A, Ibáñez B. Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events. Trials 2019; 20:677. [PMID: 31801597 PMCID: PMC6894279 DOI: 10.1186/s13063-019-3805-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vitreoretinal 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. METHODS Ninety-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. DISCUSSION This 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 REGISTRATION Clinical Trials Register EudraCT, 2018-000753-45. Registered on 11 November 2018.
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Affiliation(s)
- Jose Andonegui
- Department of Ophthalmology, Complejo Hospitalario de Navarra, 31007, Pamplona, Spain. .,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Ferran Capdevila
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, Pamplona, Spain
| | - Alicia Zubicoa
- Department of Ophthalmology, Complejo Hospitalario de Navarra, 31007, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Berta Ibáñez
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, Pamplona, Spain.,Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Pamplona, Spain
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16
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Barequet IS, Zehavi-Dorin T, Bourla N, Tamarin I, Moisseiev J, Salomon O. Safety of cataract surgery in patients treated with the new oral anticoagulants (NOACs). Graefes Arch Clin Exp Ophthalmol 2019; 257:2671-2676. [PMID: 31641883 DOI: 10.1007/s00417-019-04488-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the safety of phacoemulsification of cataract in patients taking new oral anticoagulants (NOACs). METHODS In a prospective case series, consecutive patients on NOACs (dabigatran, rivaroxaban, or apixaban) who were referred for uncomplicated cataract surgery to the eye institute underwent a thorough ophthalmological and hematological evaluation. Rivaroxaban and apixaban anti-factor Xa tests, and diluted thrombin time for dabigatran, were used for monitoring anticoagulation levels in blood. Blood was drawn for these tests just prior to surgery and at a peak level of the drug at about 4 h post-surgery (2 h after the drug was given). All surgeries were videotaped and patients were examined at 1 and 7 days after the operation. The main outcome measures included assessment of intra-operative, postoperative ocular bleeding, and other related complications. RESULTS Thirty-five eyes of 25 unrelated patients ranging in age from 63 to 92 years (mean 77.6 years) underwent phacoemulsification. Intra-operative bleeding was observed in 5 eyes from the conjunctiva or limbus at the main incision site. No intraocular bleeding occurred. No hemorrhagic complications were observed during the 1-week follow-up. According to anti-factor Xa levels prior to surgery and following surgery, 85% of the patients were on therapeutic levels of NOACs. CONCLUSIONS Clear corneal incision phacoemulsification performed under topical anesthesia can be safely performed in simple cases of cataract without discontinuing NOAC treatment.
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Affiliation(s)
- Irina S Barequet
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv University, Tel Hashomer, Israel.
| | - Tzukit Zehavi-Dorin
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv University, Tel Hashomer, Israel
| | - Nirit Bourla
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv University, Tel Hashomer, Israel
| | - Ilia Tamarin
- Institute of Thrombosis & Hemostasis, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv, University, Tel Hashomer, Israel
| | - Joseph Moisseiev
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv University, Tel Hashomer, Israel
| | - Ophira Salomon
- Institute of Thrombosis & Hemostasis, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv, University, Tel Hashomer, Israel
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Makuloluwa AK, Tiew S, Briggs M. Peri-operative management of ophthalmic patients on anti-thrombotic agents: a literature review. Eye (Lond) 2019; 33:1044-1059. [PMID: 30850731 DOI: 10.1038/s41433-019-0382-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/25/2018] [Accepted: 01/20/2019] [Indexed: 12/14/2022] Open
Abstract
There is variability in the management of ophthalmic patients on anti-thrombotic agents (antiplatelets and anticoagulants) during the peri-operative period. A survey carried out in a UK teaching hospital on a cohort of ophthalmologists showed majority were comfortable with antiplatelet management but there was variability in managing patients on warfarin and direct oral anticoagulants (DOACs); 40% were unaware of existing guidelines. We aim to review the recommendations in the literature with regards to managing anti-thrombotic agents during the peri-operative period of ophthalmic surgery. We reviewed incidences of complications, specifically, the haemorrhagic complications associated. Pubmed search was carried out on relevant keywords from January 2007 to August 2017. All relevant UK guidelines including the Royal College of Ophthalmologists and British Society of Haematology were reviewed. Literature recommendations for routine cataract surgery under topical or sub-Tenon's anaesthesia would be to continue all anti-thrombotic agents. For sharp needle anaesthesia, avoidance of dual antiplatelet therapy was recommended and warfarin could be continued if INR within therapeutic range. Recommendations for surgeries in glaucoma, vitreo-retinal, oculoplastic and lacrimal; and strabismus are presented. No evidence was found for corneal surgery. Haemorrhagic complications are reported in all groups. Limitations of this review include the retrospective nature, lack of randomized control trials and the limited evidence regarding DOACs. It is important for ophthalmologists to be aware of and balance the risk of thromboembolic events and risks of haemorrhagic complications for ophthalmic surgery. A multi-disciplinary approach is recommended for complex cases.
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Affiliation(s)
- A K Makuloluwa
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.
| | - S Tiew
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
| | - M Briggs
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
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18
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Arepalli S, Sears JE, Srivastava SK, Deasy R, Singh RP, Ehlers JP, Kaiser PK, Martin D, Sharma S, Yuan A, Schachat AP, Rachitskaya AV. Pre–Retinal Surgery Identification of Novel Anticoagulation and Antiplatelet Agents. ACTA ACUST UNITED AC 2018; 2:254-255. [DOI: 10.1016/j.oret.2017.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/16/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
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19
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Uyhazi KE, Miano T, Pan W, VanderBeek BL. Association of Novel Oral Antithrombotics With the Risk of Intraocular Bleeding. JAMA Ophthalmol 2018; 136:122-130. [PMID: 29242919 DOI: 10.1001/jamaophthalmol.2017.5677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Importance Novel oral anticoagulation and antiplatelet therapies have become a mainstay of treatment for thromboembolic disease. However, the safety profile of these medications has not been completely characterized. Objective To determine the risk of developing intraocular hemorrhages with novel oral antithrombotic therapy compared with that of traditional antithrombotic agents. Design, Setting, and Participants In this retrospective cohort study, a large national insurance claims database was used to generate 2 parallel analyses. All patients with incident use of dabigatran etexilate or rivaroxaban between January 1, 2010, and September 30, 2015, were compared with patients with incident use of warfarin sodium. Similarly, patients with new use of prasugrel hydrochloride were compared with those with new use of clopidogrel bisulfate. Both analyses required the patient to be in the insurance plan for at least 24 months prior to initiation of therapy and excluded patients with any previous diagnosis of intraocular hemorrhages or any prescription for the comparator medications. Furthermore, the antiplatelet analysis required a diagnosis of acute coronary syndrome or a myocardial infarction within 60 days of initiation of pharmacologic therapy. The anticoagulant analysis excluded patients with end-stage renal disease, renal transplants, and those with heart valve disease. Main Outcomes and Measures Incident intraocular hemorrhages at 90 and 365 days. Multivariate Cox proportional hazards regression models were used to compare the hazard ratio (HR) of developing an intraocular hemorrhage in individuals taking novel agents compared with those taking traditional medications. Results A total of 146 137 patients taking warfarin (76 714 women and 69 423 men; mean [SD] age, 69.8 [11.8] years) were compared with 64 291 patients taking dabigatran or rivaroxaban (31 576 women and 32 715 men; mean [SD] age, 67.6 [11.7] years). Cox proportional hazards regression revealed a decreased hazard for developing an intraocular hemorrhage with dabigatran or rivaroxaban at 365 days (HR, 0.75; 95% CI, 0.58-0.97; P = .03), but not at 90 days (HR, 0.73; 95% CI, 0.22-2.63; P = .13). A total of 103 796 patients taking clopidogrel (37 578 women and 66 218 men; mean [SD] age, 68.0 [11.3] years) were compared with 8386 patients taking prasugrel (1988 women and 6380 men; mean [SD] age, 61.0 [9.6] years) and no increased hazard for developing an intraocular hemorrhage with prasugrel was seen at 90 days (HR, 0.75; 95% CI, 0.29-1.92; P = .55) or 365 days (HR, 1.19; 95% CI, 0.69-2.04; P = .53). Conclusions and Relevance These results suggest a decreased risk of intraocular hemorrhage associated with novel direct thrombin inhibitors and direct factor Xa inhibitors, but no difference for P2Y12 inhibitors compared with traditional vitamin K anticoagulation and antiplatelet therapy, respectively.
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Affiliation(s)
- Katherine E Uyhazi
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Todd Miano
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Wei Pan
- Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Brian L VanderBeek
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia
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20
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Antiplatelet and anticoagulant agents in vitreoretinal surgery: a prospective multicenter study involving 804 patients. Graefes Arch Clin Exp Ophthalmol 2018; 256:461-467. [DOI: 10.1007/s00417-017-3897-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/08/2017] [Accepted: 12/29/2017] [Indexed: 01/07/2023] Open
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Sun MT, Wood MK, Chan W, Selva D, Sanders P, Casson RJ, Wong CX. Risk of Intraocular Bleeding With Novel Oral Anticoagulants Compared With Warfarin: A Systematic Review and Meta-analysis. JAMA Ophthalmol 2017; 135:864-870. [PMID: 28687831 PMCID: PMC5710315 DOI: 10.1001/jamaophthalmol.2017.2199] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
Abstract
Importance It is unclear if the risk of intraocular bleeding with novel oral anticoagulants differs compared with warfarin. Objective To characterize the risk of intraocular bleeding with novel oral anticoagulants compared with warfarin. Data Sources A systematic review and meta-analysis was undertaken in an academic medical setting. MEDLINE and ClinicalTrials.gov were searched for randomized clinical trials published up until August 2016. This search was supplemented by manual bibliography searches of identified trials and other review articles. Study Selection Studies were eligible for inclusion if they were phase 3 randomized clinical trials, enrolled patients with atrial fibrillation or venous thromboembolism, compared a novel oral anticoagulant (dabigatran, rivaroxaban, apixaban, or edoxaban) with warfarin, and recorded event data on intraocular bleeding. Data on intraocular bleeding were pooled using inverse-variance, weighted, fixed-effects meta-analysis. Data Extraction and Synthesis The PRISMA guidelines were used for abstracting data and assessing quality. Independent extraction was performed by 2 investigators. Main Outcomes and Measures Intraocular bleeding events and associated risk ratio for novel oral anticoagulants compared with warfarin. Results Twelve trials investigating 102 627 patients were included. Randomization to novel oral anticoagulants was associated with a 22% relative reduction in intraocular bleeding compared with warfarin (risk ratio, 0.78; 95% CI, 0.61-0.99). There was no significant heterogeneity observed (I2 = 4.8%, P = .40). Comparably lower risks of intraocular bleeding with novel oral anticoagulants were seen in subgroup analyses, with no significant difference according to the indication for anticoagulation (P for heterogeneity = .49) or the novel oral anticoagulant type (P for heterogeneity = .15). Summary estimates did not differ materially when random-effects meta-analytic techniques were used. Conclusions and Relevance These results suggest that novel oral anticoagulants reduce the risk of intraocular bleeding by approximately one-fifth compared with warfarin. Similar benefits were seen in both patients with atrial fibrillation and venous thromboembolism. Our data have particular relevance for patients at higher risk of spontaneous retinal and subretinal bleeding. These findings may also have important implications in the perioperative period, in which the use of novel oral anticoagulants may be superior. Future studies are required to better characterize the optimal management of patients with both ophthalmic disease and cardiovascular comorbidities requiring anticoagulation.
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Affiliation(s)
- Michelle T. Sun
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - Megan K. Wood
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - WengOnn Chan
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - Robert J. Casson
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - Christopher X. Wong
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, The University of Adelaide and Royal Adelaide Hospital, Adelaide
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, England
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22
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Patel R, Charles S, Jalil A. Antiplatelets and anticoagulants in vitreoretinal surgery, with a special emphasis on novel anticoagulants: a national survey and review. Graefes Arch Clin Exp Ophthalmol 2017; 255:1275-1285. [DOI: 10.1007/s00417-017-3664-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/17/2017] [Accepted: 03/27/2017] [Indexed: 01/28/2023] Open
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23
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Mantopoulos D, Vavvas DG, Fine HF. Perioperative Risks of Antiplatelet and Anticoagulant Drugs in Vitreoretinal Procedures. Ophthalmic Surg Lasers Imaging Retina 2017; 48:4-8. [DOI: 10.3928/23258160-20161219-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Matharu KS, Smith SV, Lee AG. Retrobulbar hemorrhage and prasugrel. CANADIAN JOURNAL OF OPHTHALMOLOGY 2016; 51:e189-e190. [PMID: 27938982 DOI: 10.1016/j.jcjo.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/05/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - Stacy V Smith
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, Houston, Texas, Department of Ophthalmology, UTMB (Galveston), Baylor College of Medicine, University of Iowa Hospitals and Clinics, and the University of Texas M.D. Anderson Cancer Center Houston, Texas.
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