![]() ![]() Therefore, it is important to understand the indications of anti-thrombotic agents and when it may be safe to discontinue them peri-operatively. Ĭontinuing anti-thrombotic agents peri-operatively may increase the risk of potentially sight-threatening haemorrhagic complications, whereas discontinuing these medications may increase the risk of life-threatening thromboembolic events. In this study, warfarin use (an anticoagulant) was reported in 0.9%, 3.9% and 3.6% of patients in 1993, 20, respectively. reported 14.6, 28.5 and 32.3 of patients undergoing vitreoretinal surgery were on antiplatelet agents in 1993, 20, respectively. With an ageing population, there is an increasing prevalence of ophthalmic patients on anti-thrombotic agents. A multi-disciplinary approach is recommended for complex cases.Īnti-thrombotic agents, used in the prevention and treatment of cardiovascular and ischaemic cerebral diseases, are classified into antiplatelet and anticoagulant agents. It is important for ophthalmologists to be aware of and balance the risk of thromboembolic events and risks of haemorrhagic complications for ophthalmic surgery. Limitations of this review include the retrospective nature, lack of randomized control trials and the limited evidence regarding DOACs. Haemorrhagic complications are reported in all groups. No evidence was found for corneal surgery. Recommendations for surgeries in glaucoma, vitreo-retinal, oculoplastic and lacrimal and strabismus are presented. For sharp needle anaesthesia, avoidance of dual antiplatelet therapy was recommended and warfarin could be continued if INR within therapeutic range. Literature recommendations for routine cataract surgery under topical or sub-Tenon’s anaesthesia would be to continue all anti-thrombotic agents. ![]() ![]() All relevant UK guidelines including the Royal College of Ophthalmologists and British Society of Haematology were reviewed. Pubmed search was carried out on relevant keywords from January 2007 to August 2017. We reviewed incidences of complications, specifically, the haemorrhagic complications associated. We aim to review the recommendations in the literature with regards to managing anti-thrombotic agents during the peri-operative period of ophthalmic surgery. 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. There is variability in the management of ophthalmic patients on anti-thrombotic agents (antiplatelets and anticoagulants) during the peri-operative period. ![]()
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