Assessing the Safety of Eyelid Surgery in Patients on Antithrombotic Therapy: Empirical Evidence Supporting...

PURPOSE: To evaluate the incidence of bleeding complications of oculoplastic procedures performed under antithrombotic therapy and local anaesthesia.

MATERIALS AND METHODS: A prospective study of patients on antithrombotics undergoing pre-septal and post-septal oculoplastic procedures under local anaesthesia over a 12-month period. The type of antithrombotic, surgical details, intra and post-operative complications were documented. Exclusion criteria were high bleeding-risk procedures, such as orbital surgery and dacryocystorhinostomy.

RESULTS: 302 patients were included, mean age was 70.7 ± 14.7. years (19 - 98). 77 patients (25.5%) on antithrombotics were advised to continue their medication prior to surgery. The types of antithrombotics taken by patients at the time of surgery were 60.9% antiplatelets, 33.3% anticoagulants and 5.8% combination therapy. Amongst patients who continued taking their oral antithrombotic medications, there was no major intraoperative or perioperative bleeding complications, and no patients required additional surgical or medical reintervention. One self-resolving postoperative bleed occurred after upper-lid blepharoplasty in a patient on aspirin and rivaroxaban. Bleeding rates did not differ between patients who continued antithrombotics and those not receiving antithrombotics (p = 1.00).

CONCLUSION: This study found no incidence of severe bleeding complications in oculoplastic procedures among patients continuing anticoagulant or antiplatelet therapy, consistent with existing literature. Continuation of anticoagulants and antiplatelets appears safe for selected procedures, simplifying patient management and minimizing thromboembolic risk. Emphasis should be placed on meticulous intraoperative haemostasis rather than discontinuation of antithrombotic therapy.