title: Management of antithrombotic therapies in patients scheduled for eye surgery.
abstract: The large majority of patients undergoing ophthalmic surgery are elderly and take systemic medications on a regular basis, including antiplatelet and anticoagulant treatments. It is current practice for many physicians to discontinue antithrombotic treatment prior to surgery to reduce bleeding complications that may lead to retrobulbar haemorrhage and, ultimately, to loss of vision. However, discontinuation of antithrombotic treatment in such patients may lead to thromboembolic events with serious consequences. The present narrative review highlights the risk of thrombosis when discontinuing antithrombotic drugs and the risk of bleeding when continuing them. The published literature on this topic shows that discontinuation of antiplatelet or anticoagulant treatment leads to a substantially increased risk of arterial or venous thromboembolic events and related complications, especially in patients with atrial fibrillation, prosthetic heart valves or recent coronary stenting. This risk is distinctly higher than the risk of significant local haemorrhage. Ophthalmic bleeding events reported in the literature are usually minor, without serious consequences, even if antiplatelet or anticoagulant treatments are continued, provided that the anticoagulation level is within the therapeutic range. Thus, the current data are in favour of maintaining antiplatelet and anticoagulant drugs for most ophthalmic procedures, regardless of the anaesthetic techniques.
authors.affiliation: Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland. Fanny.Bonhomme@hcuge.ch
authors.forename: Fanny
authors.initials: F
authors.lastname: Bonhomme
authors.forename: Farhad
authors.initials: F
authors.lastname: Hafezi
authors.forename: Françoise
authors.initials: F
authors.lastname: Boehlen
authors.forename: Walid
authors.initials: W
authors.lastname: Habre
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002387:Cataract Extraction / Q000379:methods; D005128:Eye Diseases / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005901:Glaucoma / Q000601:surgery; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control; D057586:Vitreoretinal Surgery / Q000379:methods
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors