Management of antithrombotic therapies in patients scheduled for eye surgery

Area of Science:

• Ophthalmology
• Cardiology
• Geriatrics

Background:

• Elderly patients frequently require ophthalmic surgery.
• Many elderly patients use antiplatelet and anticoagulant medications.
• Current practice often involves discontinuing antithrombotic therapy before surgery to prevent bleeding.

Purpose of the Study:

• To review the risks of discontinuing antithrombotic treatment versus continuing it for ophthalmic surgery.
• To evaluate the balance between bleeding complications and thromboembolic events in patients on antithrombotic therapy.

Main Methods:

• Narrative review of published literature.
• Analysis of risks associated with antithrombotic drug discontinuation.
• Assessment of bleeding versus thrombosis risks in ophthalmic surgery patients.

Main Results:

• Discontinuing antiplatelet or anticoagulant therapy significantly increases the risk of arterial or venous thromboembolic events.
• This increased thromboembolic risk is particularly notable in patients with atrial fibrillation, prosthetic heart valves, or recent coronary stenting.
• Ophthalmic bleeding events are typically minor and without severe consequences when antithrombotic therapy is maintained within the therapeutic range.

Conclusions:

• The risk of serious thromboembolic events from discontinuing antithrombotic drugs outweighs the risk of significant bleeding during ophthalmic surgery.
• Maintaining antiplatelet and anticoagulant therapy is recommended for most ophthalmic procedures.
• This recommendation holds true regardless of the anesthetic technique used.