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Warfarin in vitreoretinal surgery: a case controlled series.

Aman Chandra¹, Fiona Jazayeri, Tom H Williamson

¹Vitreoretinal Department, Moorﬁelds Eye Hospital, London, UK.

The British Journal of Ophthalmology

|November 13, 2010

Summary

Continuing warfarin therapy during vitreoretinal surgery showed no increased complications. However, patients with rhegmatogenous retinal detachment (RRD) on warfarin may experience more vitreous hemorrhage at presentation.

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Area of Science:

Ophthalmology
Vitreoretinal Surgery
Pharmacology

Background:

Warfarin is a widely used anticoagulant.
Its impact on vitreoretinal surgery outcomes is not well-established.

Purpose of the Study:

To investigate the safety and complications of continuing warfarin therapy in patients undergoing pars plana vitrectomy.
To assess the association between warfarin use and vitreous hemorrhage in patients with rhegmatogenous retinal detachment (RRD).

Main Methods:

Retrospective case-controlled study of 60 patients on warfarin undergoing pars plana vitrectomy compared to 60 controls.
Online survey of current UK practices regarding warfarin management before vitreoretinal surgery.

Main Results:

No increase in complications was observed in patients continuing warfarin compared to controls.
Patients with RRD on warfarin had a higher incidence of vitreous hemorrhage at presentation (p=0.04).
81% of surveyed UK practitioners would advise withholding warfarin before surgery based on INR.

Conclusions:

Continuing warfarin therapy appears safe for patients undergoing vitreoretinal surgery, with no observed increase in complications.
Warfarin use may be associated with an increased risk of presenting vitreous hemorrhage in RRD patients.
Current clinical practice in the UK often involves withholding warfarin prior to surgery.