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Anticoagulation: a practical guide for strabismus surgeons
Shira L Robbins1, Jeffrey W Wang2, Jeffrey R Frazer3
1Viterbi Family Department of Ophthalmology, University of California, San Diego; Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego.
Insights
Managing patients on blood thinners undergoing strabismus surgery requires balancing bleeding and clotting risks. This review guides surgeons on perioperative anticoagulant and antiplatelet drug use to minimize complications.
Area of Science:
- Ophthalmology
- Cardiology
- Pharmacology
Background:
- Increasing use of diverse oral anticoagulants and antiplatelet agents in strabismus surgery patients.
- Perioperative management decisions are complex, balancing hemorrhagic versus thrombotic risks.
Purpose of the Study:
- To review hemorrhagic complications of strabismus surgery.
- To examine perioperative anticoagulant and antiplatelet drug use.
- To discuss surgical strategies for minimizing intraoperative hemorrhage.
Main Methods:
- Literature review of strabismus surgery complications.
- Analysis of perioperative management of anticoagulant and antiplatelet therapies.
- Discussion of surgical techniques to reduce bleeding.
Main Results:
- Identification of potential hemorrhagic risks associated with strabismus surgery.
- Evaluation of current practices for managing patients on antithrombotic medications.
- Exploration of surgical modifications to mitigate bleeding.
Conclusions:
- Careful consideration of individual patient risk is crucial for perioperative management.
- Optimizing surgical techniques can help reduce bleeding in patients on anticoagulant therapy.
- Further research may be needed to establish definitive guidelines.
Abstract:
An increasing number of surgical strabismus patients are taking oral anticoagulant and antiplatelet agents, with more diverse mechanisms of action than those used in the past. The decision as to whether to continue these drugs throughout the perioperative period is difficult and must be based on the balance between hemorrhagic and thrombotic risk. To help guide strabismus surgeons with clinical management in these cases, we review potential hemorrhagic complications of strabismus surgery and examine the use of anticoagulant and antiplatelet drugs during the perioperative period. Surgical strategies that might help minimize intraoperative hemorrhage in patients on anticoagulant therapy are also discussed.
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