Ophthalmic Patients on Antithrombotic Drugs
Ophthalmic Patients on Antithrombotic Drugs
There is no randomised controlled trial that directly compares the thromboembolic events rate and the haemorrhagic anaesthetic and surgical complications rate in ophthalmic surgical patients. Therefore, evidence on which to draw recommendations is based on prospective and retrospective cohort studies and expert committee reports.
Severe sight-threatening haemorrhagic complications associated with local anaesthetic eye blocks are rare, and the use of warfarin and antiplatelet agents is not associated with an increase in these complications. Routine cataract, V-R and oculoplastic surgery appears to be safe in patients on warfarin and antiplatelet agents. For urgent or complex surgery or where there are specific concerns, there should be multidisciplinary discussion regarding the risks and benefits of continuing or discontinuing anticoagulants and antiplatelet agents and the proposed surgery to agree an acceptable approach.
In future, there is likely to be an exponential increase in elderly patients on anticoagulants and antiplatelet agents presenting for eye surgery due to changing patient demographics.
The evidence we now have to base our clinical decisions relates only to the current cohort of patients, but the clinical profile of serious complications in increasingly elderly patients undergoing eye surgery of varying complexity is likely to change. Therefore, there is a requirement to continually review the evidence to guide clinical practice.
As new anticoagulants and antiplatelet agents are introduced into clinical practice, close collaboration between anaesthetists, surgeons and physicians in the perioperative care of these high-risk patients assumes ever greater importance. The greater potency and rapid onset of action of the newer oral anticoagulant and antiplatelet agents adds to the complexity of managing these patients.
Conclusions
There is no randomised controlled trial that directly compares the thromboembolic events rate and the haemorrhagic anaesthetic and surgical complications rate in ophthalmic surgical patients. Therefore, evidence on which to draw recommendations is based on prospective and retrospective cohort studies and expert committee reports.
Severe sight-threatening haemorrhagic complications associated with local anaesthetic eye blocks are rare, and the use of warfarin and antiplatelet agents is not associated with an increase in these complications. Routine cataract, V-R and oculoplastic surgery appears to be safe in patients on warfarin and antiplatelet agents. For urgent or complex surgery or where there are specific concerns, there should be multidisciplinary discussion regarding the risks and benefits of continuing or discontinuing anticoagulants and antiplatelet agents and the proposed surgery to agree an acceptable approach.
In future, there is likely to be an exponential increase in elderly patients on anticoagulants and antiplatelet agents presenting for eye surgery due to changing patient demographics.
The evidence we now have to base our clinical decisions relates only to the current cohort of patients, but the clinical profile of serious complications in increasingly elderly patients undergoing eye surgery of varying complexity is likely to change. Therefore, there is a requirement to continually review the evidence to guide clinical practice.
As new anticoagulants and antiplatelet agents are introduced into clinical practice, close collaboration between anaesthetists, surgeons and physicians in the perioperative care of these high-risk patients assumes ever greater importance. The greater potency and rapid onset of action of the newer oral anticoagulant and antiplatelet agents adds to the complexity of managing these patients.