No clear agreement on anticoagulation decisions in MIGS
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Key takeaways:
- There is no clear agreement on who should make decisions regarding anticoagulants before MIGS.
- More research is needed on bleeding complication rates in MIGS.
There is no clear agreement on how to handle anticoagulation decisions before minimally invasive glaucoma surgery, according to a speaker at the American Glaucoma Society meeting.
Tejus Pradeep, MD, said the literature on anticoagulants in MIGS has been limited, and he and colleagues wanted to find out what glaucoma surgeons thought about the topic.
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They created an online anonymized survey for AGS members using standard definitions of anticoagulants and antiplatelet agents, as well as six broad definitions of MIGS procedures.
Among the 103 surgeons who responded, the most commonly performed MIGS categories were trabecular meshwork bypass with tissue excision (41%) and trabecular meshwork bypass with device implantation (27%).
Pradeep said surgeons were divided on who should make the decision on anticoagulants. In the survey, 51% deferred to a primary care provider most or all of the time, and 47% sometimes or never did.
A majority of surgeons (69%) said they thought about anticoagulation before every MIGS procedure, and 59% said they managed anticoagulation for MIGS differently from trabeculectomy or tube surgery.
Additionally, 85% of surgeons said they never used a bleeding risk score to help in decision-making, and 86% did not alter their surgical technique most of the time.
Pradeep said the next step is to conduct more research and find out what the actual bleeding complication rates are in MIGS so the glaucoma community does not need to rely on self-reported data. He also suggested that a MIGS-specific bleeding risk score would be useful.
“A key limitation of our study was the indication for why someone was on anticoagulation in the first place,” he said. “A lot of people said that didn’t matter to them and their management, and a lot said that they didn’t want to mess with people who had stroke risk and preferred to keep it on. A discussion of surgical techniques could be useful as well.”
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Pradeep T, et al. Perioperative anticoagulation management patterns related to minimally invasive glaucoma surgery (MIGS). Presented at: American Glaucoma Society meeting; March 2-5, 2022; Austin, Texas.
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