title: [Managing antithrombotic therapy in vitreoretinal surgery].
abstract: Given the growing number of patients on antithrombotic therapy we are increasingly confronted with the management of this therapy before, during and after vitreoretinal surgery. In the absence of a consensus, the decision to withdraw antithrombotic therapy is based on the cardiovascular thromboembolism risk versus the theoretical risk of bleeding if the antithrombotic treatment is continued. As suggested by the literature, antiplatelet therapy (acetylsalicylic acid or clopidogrel) may be safely continued for vitreoretinal surgery, including retinal detachment repair. However, the risk/benefit ratio for patients being treated with two antiplatelet therapies is unknown. It appears that an International Normalized Ratio (INR) less than 3 for patients treated with anticoagulant therapy does not increase the perioperative risk of ocular bleeding. This risk has not been evaluated in patients treated by new antithrombotic therapies (prasugrel, ticagrelor as antiplatelet medication, or dabigatran, rivaroxaban, apixaban as anticoagulant therapy), and there is a need to study it further.
authors.affiliation: Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France.
authors.forename: M
authors.initials: M
authors.lastname: Gallice
authors.affiliation: Centre ophtalmologique Kleber, 50, cours Franklin-Roosevelt, 69006 Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Rouberol
authors.affiliation: Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France; Département d'anesthésie-réanimation, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: P
authors.initials: P
authors.lastname: Albaladejo
authors.affiliation: Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: E
authors.initials: E
authors.lastname: Brillat Zaratzian
authors.affiliation: Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France.
authors.forename: K
authors.initials: K
authors.lastname: Palombi
authors.affiliation: Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France.
authors.forename: F
authors.initials: F
authors.lastname: Aptel
authors.affiliation: Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Romanet
authors.affiliation: Clinique universitaire d'ophtalmologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Joseph-Fourier, 621, avenue Centrale, 38041 Saint-Martin-d'Hères, France. Electronic address: cchiquet@chu-grenoble.fr.
authors.forename: C
authors.initials: C
authors.lastname: Chiquet
mesh_terms: D000772:Anesthesia, Local; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology; D005128:Eye Diseases / Q000601:surgery; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D019934:International Normalized Ratio; D007431:Intraoperative Complications / Q000517:prevention & control; D008954:Models, Biological; D013508:Ophthalmologic Surgical Procedures; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012164:Retinal Diseases / Q000150:complications / Q000601:surgery; D018570:Risk Assessment; D013923:Thromboembolism / Q000517:prevention & control*; D019851:Thrombophilia / Q000150:complications / Q000188:drug therapy; D014822:Vitreous Body / Q000601:surgery
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin
keywords: Antiagrégant plaquettaire; Anticoagulant; Anticoagulation therapy; Antiplatelet therapy; Chirurgie vitréorétinienne; Hémorragie périopératoire; Perioperative bleeding; Vitreoretinal surgery