title: Risk of Hemorrhage during Needle-Based Ophthalmic Regional Anesthesia in Patients Taking Antithrombotics: A Systematic Review.
abstract: BACKGROUND
  Patients undergoing ophthalmic surgery are usually elderly and, due to systemic disease, may be on long-term therapy, such as antithrombotic agents. Rates of hemorrhagic complications associated with invasive procedures may be increased by the use of anticoagulants and antiplatelet agents.
  
  
  OBJECTIVE
  To compare the incidence of hemorrhagic complications in patients undergoing needle-based ophthalmic regional anesthesia between patients on antithrombotic therapy and those not on such therapy.
  
  
  METHODS
  A systematic review was conducted by two independent reviewers based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the "gray" literature (Google Scholar). The end search date was May 8, 2015, across all databases.
  
  
  RESULTS
  Five studies met the eligibility criteria. In three studies, individual risk of bias was low, and in two of them, moderate. In all studies, no differences regarding mild to moderate incidence of hemorrhagic complications were found between patients using antithrombotics (aspirin, clopidogrel, and warfarin) and those not using them. Rates of severe hemorrhagic complication were very low (0.04%) in both groups, supporting the safety of needle blocks, even in patients using antithrombotics. High heterogeneity across studies prevented meta-analysis. Limitations to these results include low statistical power in three experimental studies and a large 95% confidence interval in the two retrospective cohorts.
  
  
  CONCLUSIONS
  In this review, none of the selected studies showed significant bleeding related to needle-based ophthalmic regional anesthesia in association with the use of aspirin, clopidogrel, or vitamin K inhibitors. Since the available data is not powerful enough to provide a reliable evaluation of the true effect of antithrombotics in this setting, new studies to address these limitations are necessary.
authors.affiliation: Florianópolis Hospital, Florianópolis, Brazil.|Sianest-Anesthesiology Service, Florianópolis, Brazil.|Brazilian Centre for Evidence-based Research, Health Sciences Centre, Federal University of Santa Catarina, Florianópolis, Brazil.
authors.forename: Augusto
authors.initials: A
authors.lastname: Takaschima
authors.affiliation: Florianópolis Hospital, Florianópolis, Brazil.
authors.forename: Patricia
authors.initials: P
authors.lastname: Marchioro
authors.affiliation: Unisul-Universidade do Sul de Santa Catarina, Tubarão, Brazil.
authors.forename: Thiago M
authors.initials: TM
authors.lastname: Sakae
authors.affiliation: Brazilian Centre for Evidence-based Research, Health Sciences Centre, Federal University of Santa Catarina, Florianópolis, Brazil.|University of São Paulo, Bauru, Brazil.
authors.forename: André L
authors.initials: AL
authors.lastname: Porporatti
authors.affiliation: Unisul-Universidade do Sul de Santa Catarina, Tubarão, Brazil.
authors.forename: Luis André
authors.initials: LA
authors.lastname: Mezzomo
authors.affiliation: Unisul-Universidade do Sul de Santa Catarina, Tubarão, Brazil.|Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Graziela
authors.initials: G
authors.lastname: De Luca Canto
mesh_terms: D000772:Anesthesia, Local / Q000009:adverse effects; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies
chemical_list: D005343:Fibrinolytic Agents