This article is more than 5 years old. Information may no longer be current.
Diabetic vitrectomy patients on anticoagulation agents may have no increased risk of hemorrhage
Retina. 2011;31(10):1983-1987.
Click Here to Manage Email Alerts
The first study to assess vitreous hemorrhage in patients on anticoagulation or antiplatelet agents undergoing diabetic vitrectomy suggested no increased risk.
Ninety-seven eyes were included, with 27 remaining on anticoagulation medications during diabetic pars plana vitrectomy. Surgery was conducted by a single ophthalmologist over a 30-month period at a single institution in this retrospective cohort study.
No perioperative complications related to anticoagulation use arose, and no difference in incidence of postoperative vitreous hemorrhage or reoperation between the two groups was shown.
However, while vitrectomy resulted in significant visual acuity enhancements in the two groups, those who received anticoagulation agents exhibited significantly worse acuity (P = .03). These eyes may have more vascular damage, making them less likely to recover visually, the study authors said.
Notably, the anticoagulation cohort included patients on various combinations of anticoagulation and antiplatelet medications, causing conclusions for individual agents to be unknown. Additionally, study outcomes may be limited by the ceasing of therapy perioperatively, which may have affected hemorrhage rates, and more judicious attempts to decrease hemorrhage in eyes remaining on anticoagulation.
For decades, I have made the point that anticoagulation therapy should never be withdrawn before intraocular surgery because of the increased risk of myocardial infarction, stroke, deep venous thrombosis and pulmonary embolism, as has been shown in the literature. A few anecdotal case reports have suggested bleeding complications in anti-coagulated patients, but there has been no large series validating this concern. The study conducted by Brown and colleagues makes the important point that postoperative vitreous hemorrhage is not more common in anti-coagulated patients undergoing vitrectomy for diabetic vitreous hemorrhage. It is unacceptable to potentially cause morbidity and mortality by withdrawing anti-coagulation before intraocular surgery when there is no benefit from an ocular bleeding standpoint.
– Steve Charles, MD, FACS, FICS
Clinical
Professor of Ophthalmology, University of Tennessee
Disclosure: Dr.
Charles has no relevant financial disclosures.
Reference:
- Charles S, Rosenfeld PJ, Gayer S. Medical consequences of stopping anticoagulant therapy before intraocular surgery or intravitreal injections. Retina. 2007;27(7):813-815.