Low bleeding risk associated with anticoagulant, antiplatelet medication use during 25-gauge PPV

Anticoagulant and antiplatelet therapy have historically been discontinued before ocular surgery to reduce the risk of vision-threatening hemorrhagic complications, but discontinuingthese medications can increase the risk of thromboembolic and cerebrovascular events. The ophthalmologic community has yet to reach a unified consensus regarding the risks of systemic anticoagulation or platelet inhibition during ocular surgery and whether continuation of such medication is appropriate. The literature on vitreoretinal procedures is particularly sparse.

Although many aspects of smaller-gauge pars plana vitrectomy (PPV) have been investigated, the risk of ocular hemorrhage in either systemically anticoagulated patients or in patients taking platelet inhibitors has not yet been reported.

To investigate this question, researchers retrospectively estimated the risk of hemorrhagic complications among 289 consecutive patients who underwent 25-gaugePPVwhile taking systemic warfarin or clopidogrel and compared it to PPV patients not on anticoagulant therapy.

There was one occurrence of transient vitreous hemorrhage in the warfarin group, five in the clopidogrel group, and four in the control group. No patient experienced anesthesia-related hemorrhagic complications resulting from peribulbar or retrobulbar block, and no choroidal or retrobulbar hemorrhages occurred in any patient.

The authors conclude that given the risks associated with stopping antiplatelet or anticoagulant therapy, they suggest patients continue their therapeutic regimen.