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Antiplatelets and anticoagulants in vitreoretinal surgery, with a special emphasis on novel anticoagulants: a national survey and review

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Abstract

Purpose

To survey current practice and opinion regarding the cessation of antiplatelet and anticoagulant agents prior to vitreoretinal surgery, with special emphasis on novel anticoagulants, and to provide an overview of current literature.

Methods

An online survey was sent to 167 members of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS). A literature search and analysis was conducted on studies that reviewed the bleeding risk of antiplatelet and anticoagulant agents.

Results

The majority (93% for aspirin, 82% for clopidogrel) of respondents would not suspend antiplatelet administration, and 79% would not stop warfarin before vitreoretinal surgery. Regarding the novel anticoagulants (factor Xa inhibitors), 58% would not stop them, and 24% were unsure. Eighty-three percent of the surgeons were not confident regarding the management of factor Xa inhibitors preoperatively. Thirty-one percent of the respondents felt that anticoagulation cessation was independent of the type of vitreoretinal surgery, whereas 9% each felt that they would stop anticoagulation if possible for diabetic vitrectomy and retinectomy. Published evidence suggests that antiplatelet agents and warfarin do not confer a significantly greater risk of intra- or perioperative bleeding. Evidence regarding the novel anticoagulants is sparse.

Conclusions

Further evaluation of novel anticoagulants in vitreoretinal surgery is required in order to provide evidence-based recommendations and address variations in practice.

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Authors and Affiliations

  1. Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre and Institute of Human Development, University of Manchester, Manchester, UK

    Rupa Patel, Stephen Charles & Assad Jalil

  2. Vitreoretinal Surgeon and Uveitis Specialist, Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WH, UK

    Assad Jalil

Authors
  1. Rupa Patel
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  2. Stephen Charles
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  3. Assad Jalil
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Correspondence to Assad Jalil.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

Informed consent was obtained from all individual participants included in the study.

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Patel, R., Charles, S. & Jalil, A. Antiplatelets and anticoagulants in vitreoretinal surgery, with a special emphasis on novel anticoagulants: a national survey and review. Graefes Arch Clin Exp Ophthalmol 255, 1275–1285 (2017). https://doi.org/10.1007/s00417-017-3664-3

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  • DOI: https://doi.org/10.1007/s00417-017-3664-3

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