title: Maintenance of perioperative antiplatelet and anticoagulant therapy for vitreoretinal surgery.
abstract: BACKGROUND
  The objective of this study was to prospectively assess the risk of bleeding from vitreoretinal surgery in a continuous unbiased cohort of patients taking unsuspended antiplatelet or anticoagulant therapy.
  
  
  METHODS
  Prospective hospital-based study.
  
  
  METHODS
  Eighty-five patients taking unsuspended aspirin, clopidogrel and/or warfarin therapy undergoing all forms of vitreoretinal surgery at The Mater Misericordiae University and The Mater Private Hospital, Dublin, Ireland.
  
  
  METHODS
  Consecutive patients undergoing vitreoretinal surgery taking unsuspended antiplatelet or anticoagulant therapy over a 1-year period were included in this prospective study to evaluate the intraoperative and postoperative bleeding complications.
  
  
  METHODS
  The intraoperative and postoperative bleeding rates.
  
  
  RESULTS
  One hundred and seven vitreoretinal procedures were performed on 85 patients taking unsuspended antiplatelet or anticoagulant therapy. The intraoperative bleeding rate was 23%, the majority of which consisted of mild bleeding into the vitreous cavity during vitrectomy. The postoperative bleeding rate was 22%, consisting of 3.7% anterior chamber haemorrhage, 11% dispersed vitreous cavity haemorrhage, 4.7% dense vitreous cavity haemorrhage, 0.9% subretinal haemorrhage and 1.9% localized choroidal haemorrhage. The single greatest significant independent predictor of intraoperative bleeding was proliferative diabetic retinopathy and of postoperative bleeding was the presence of diabetes mellitus.
  
  
  CONCLUSIONS
  There were no cases of uncontrolled intraoperative haemorrhage or serious postoperative choroidal haemorrhage. Mild haemorrhagic oozing during vitrectomy and dispersed vitreous cavity haemorrhage postoperatively were common. For the majority of patients taking antiplatelet or anticoagulant medication, these agents can be safely continued in the vitreoretinal surgical perioperative period.
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ryan
authors.forename: Tahira
authors.initials: T
authors.lastname: Saad
authors.forename: Caitriona
authors.initials: C
authors.lastname: Kirwan
authors.forename: David J
authors.initials: DJ
authors.lastname: Keegan
authors.forename: Robert W
authors.initials: RW
authors.lastname: Acheson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000188:drug therapy; D002832:Choroid Hemorrhage / Q000139:chemically induced; D000077144:Clopidogrel; D005130:Eye Hemorrhage / Q000139:chemically induced; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000139:chemically induced; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D057586:Vitreoretinal Surgery; D014823:Vitreous Hemorrhage / Q000139:chemically induced; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin