Comparison of hemorrhagic complications of warfarin and clopidogrel bisulfate in 25-gauge vitrectomy versus a control group.
OBJECTIVE
To estimate the risk of hemorrhagic complications associated with 25-gauge pars plana vitrectomy (PPV) when warfarin (Coumadin; Bristol-Myers Squibb, New York, NY) or clopidogrel (Plavix; Bristol-Myers Squibb) are continued throughout the surgical period, as compared with a control group.


METHODS
A single-center, retrospective, cohort study of 289 consecutive patients receiving either warfarin therapy or clopidogrel therapy or neither of those therapies who underwent 25-gauge PPV.


METHODS
Included were 61 patients (64 eyes; 64 PPV procedures) in the warfarin group and 118 (125 eyes; 136 PPV procedures) in the clopidogrel group. Warfarin patients were subdivided into 4 groups by international normalized ratio (INR). A control group included 110 patients (110 eyes; 110 PPV procedures) who were not receiving warfarin or clopidogrel.


METHODS
Retrospective chart review for which the criteria included: 25-gauge PPV, minimum age of 19 years, warfarin or clopidogrel use, and, if taking warfarin, an INR obtained within 5 days of surgery.


METHODS
Incidence of intraoperative and postoperative hemorrhagic complications.


RESULTS
The most common indications for anticoagulation therapy included: atrial fibrillation (38%), valvular heart disease (17%), and thromboembolic disease (16%). The most common indications for antiplatelet therapy included: cardiac stent (49%), coronary artery bypass grafting (24%), and history of transient ischemic attack (16%). No patient experienced anesthesia-related hemorrhagic complications resulting from peribulbar or retrobulbar block. Transient vitreous hemorrhage occurred in 1 (1.6%) of 64 PPV procedures in the warfarin group (P = 0.6531), 5 (3.7%) of 136 PPV procedures in the clopidogrel group (P = 1.0), and 4 (3.6%) of 110 PPV procedures in the control group. No choroidal or retrobulbar hemorrhages occurred in any patient.


CONCLUSIONS
The rate of 25-gauge PPV hemorrhagic complications in patients who underwent systemic anticoagulation or who were receiving platelet inhibitor therapy is extremely low. Given the risks associated with stopping these therapies, the authors recommend that patients continue their current therapeutic regimen without cessation.
Mason
John O
JO
Retina Consultants of Alabama, Birmingham, Alabama 35233, USA. retinarounds@mac.com
Gupta
Shelly R
SR
Compton
Christopher J
CJ
Frederick
Paul A
PA
Neimkin
Michael G
MG
Hill
Mark L
ML
Heersink
Mila J
MJ
Vail
Rachel S
RS
White
Milton F
MF
Feist
Richard M
RM
Thomley
Martin L
ML
Albert
Michael A
MA
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000188:drug therapy; D002832:Choroid Hemorrhage / Q000175:diagnosis / Q000209:etiology; D000077144:Clopidogrel; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008866:Microsurgery; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011183:Postoperative Complications; D012164:Retinal Diseases / Q000601:surgery; D019315:Retrobulbar Hemorrhage / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000009:adverse effects*; D014823:Vitreous Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D014859:Warfarin / Q000008:administration & dosage*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine