Antiplatelets, anticoagulants do not raise bleeding risk after vitreoretinal surgery

Am J Ophthalmol. 2011;151(6):934-939.

Use of antiplatelet therapy did not significantly increase the risk of postoperative intraocular bleeding after vitreoretinal surgery, a study found.

However, the risk of bleeding was reduced when antiplatelet therapy was suspended, the study authors said.

Anticoagulant use was associated with a slightly elevated risk of bleeding but no serious complications, they said.

“Decisions to suspend antiplatelet or anticoagulant therapy should be made in conjunction with the patient’s internist,” the authors said. “If suspension is not possible, or deemed safe, risk of adverse outcomes or morbidity due to postoperative bleeding is so low that it should not categorically obviate urgent or necessary vitreoretinal surgical intervention.”

The retrospective case control study included 822 eyes of 822 patients who underwent vitreoretinal surgery between 1994 and 2008. Mean patient age was 63 years; 740 patients underwent pars plana vitrectomy and 82 patients had scleral buckling.

In the study, 213 patients underwent surgery in 1994, 361 patients had surgery in 2004 and 248 patients had surgery in 2008. Of all patients, 214 patients had used antiplatelet therapy and 25 patients had used anticoagulants.

Study results showed that 20% of patients who did not suspend antiplatelet therapy and 9.6% of those who suspended therapy experienced postoperative bleeding; the difference was statistically insignificant after multivariate analysis.

Anticoagulant use was associated with intraocular hemorrhage 1 day after vitrectomy (P = .03).

No failures or re-operations were attributable to hemorrhage among patients using antiplatelets or anticoagulants, the authors reported.