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Ocular surgery on patients receiving long-term warfarin therapy
S P Gainey1, D M Robertson, W Fay
1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Warfarin sodium therapy increases perioperative hemorrhagic complications in ocular surgery patients. Discontinuing warfarin did not significantly reduce these risks compared to continuing therapy.
Area of Science:
- Ophthalmology
- Cardiology
- Pharmacology
Background:
- Long-term warfarin sodium therapy is common for preventing thromboembolic events.
- Ocular surgery presents a risk of bleeding complications.
- The management of warfarin in patients undergoing surgery requires careful consideration.
Purpose of the Study:
- To compare the incidence of hemorrhagic and thrombotic complications in patients undergoing ocular surgery.
- To evaluate the safety of continuing or discontinuing warfarin sodium therapy during the perioperative period.
Main Methods:
- Retrospective analysis of 50 patients on long-term warfarin sodium therapy who had ocular surgery.
- Comparison of complication rates between three groups: warfarin continued, warfarin discontinued, and matched controls.
- Statistical analysis to determine the significance of observed differences.
Main Results:
- The warfarin-treated group experienced six perioperative hemorrhagic complications (12%), significantly higher than the control group (P < .03).
- No significant difference in hemorrhagic complications was found between patients who continued warfarin and those who discontinued it.
- No thrombotic complications were explicitly mentioned in the provided abstract text.
Conclusions:
- Continuing warfarin sodium therapy during ocular surgery was associated with an increased risk of perioperative hemorrhage compared to controls.
- Discontinuing warfarin perioperatively did not significantly alter the risk of hemorrhagic complications compared to continuing therapy.
- These findings suggest a need for careful risk-benefit assessment when managing warfarin in patients undergoing ocular surgery.
Abstract:
We analyzed data of 50 patients receiving long-term warfarin sodium therapy who underwent ocular surgery between 1982 and 1986. The frequency of hemorrhagic and thrombotic complications was compared in patients in whom anticoagulants were continued, those in whom the anticoagulants were discontinued in the perioperative period, and a group of matched control patients. There were six perioperative hemorrhagic complications in the warfarin-treated group (12%) compared to none in the control group. This difference was significant (P less than .03). However, no significant difference in hemorrhagic complications was seen between patients in whom warfarin sodium was continued and those in whom it was discontinued.