Antiplatelets and anticoagulants in glaucoma surgery and laser

Area of Science:

• Ophthalmology
• Cardiology
• Pharmacology

Background:

• Cardiovascular diseases are increasing, leading to more patients using anticoagulant medications.
• Anticoagulants are crucial for managing comorbidities but pose bleeding risks during ophthalmic surgery.
• Practices vary significantly regarding anticoagulant use before glaucoma surgery, unlike cataract surgery.

Purpose of the Study:

• To explore the current understanding and practices surrounding anticoagulant medication management before glaucoma surgery.
• To highlight the lack of conclusive evidence regarding the optimal approach to anticoagulation in glaucoma surgery.
• To emphasize the need for careful consideration and multidisciplinary consultation when modifying anticoagulation therapy.

Main Methods:

• Review of current literature and clinical practices concerning anticoagulation and glaucoma surgery.
• Analysis of the risks and benefits of continuing or discontinuing anticoagulant therapy.
• Identification of the need for evidence-based guidelines.

Main Results:

• There is significant variability among surgeons regarding the management of anticoagulation before glaucoma surgery.
• Existing evidence is insufficient to guide decisions on continuing, withholding, or bridging anticoagulation therapy.
• Stopping anticoagulation poses risks of thrombotic events, while continuing increases hemorrhage risk.

Conclusions:

• Management of anticoagulation therapy for glaucoma surgery is complex and lacks clear guidelines.
• Decisions must be individualized, weighing bleeding risks against thrombotic risks.
• Close collaboration with primary care physicians, cardiologists, internists, and neurologists is essential.