Patients who undergo an ophthalmic procedure and are concomitantly taking antithrombotic drugs, i.e., antiplatelets and anticoagulants, during the perioperative period may require different management than patients not taking those drugs.
Investigators at St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, UK, surveyed ophthalmologists concerning this scenario and reported that most physicians were comfortable with managing patients taking antiplatelets. However, the survey indicated that the situation was not so clear-cut when patients were taking warfarin and direct oral anticoagulants (DOACs).
A.K. Makuloluwa, MD, et al. reported in Eye that “…there was variability in managing patients on warfarin and DOACs.”
A startling finding was that “40% [of ophthalmologists] were unaware of existing guidelines” for managing these patients. The authors’ concerns regarding this matter are well-founded in that, for example, within the aging population, more patients are taking these drugs to prevent and treat cardiovascular and ischemic cerebral disease.
“Continuing anti-thrombotic agents perioperatively may increase the risk of potentially sight-threatening haemorrhagic complications, whereas discontinuing these medications may increase the risk of life-threatening thromboembolic events,” investigators noted. “Therefore, it is important to understand the indications of anti-thrombotic agents and when it may be safe to discontinue them perioperatively.”