When to stop antiplatelets & anticoagulants before VR Surgery?
High thromboembolic risk conditions – mechanical heart valves, venous thromboembolism last 3 months, AF with previous stroke
High bleeding risk procedure – diabetic vitrectomy, retinectomy procedures, surgery for vascular lesions, scleral buckle (esp with external drainage)
Antiplatelets (eg. aspirin, clopidogrel, prasugrel, ticagrelor, dipyridamole, abciximab):
Monotherapy – not stopped
Dual therapy – little evidence
Little evidence based for stopping 7-10 days
Beware clopidogrel & prasugrel – if stopped, clopidogrel is for 7 days ad prasugrel for 10 days.
Not stopped if therapeutic
Defer elective surgery if above therapeutic range for patient
Risk of bleeding similar or lower than antiplatelets
NOAC - novel oral anticoagulants (eg. rivaroxaban, apixaban, dabigatran)
High thromboembolic risk / high bleeding risk procedure – consider bridging therapy (consult physician) or continue NOAC
High thromboembolic risk / moderate bleeding risk procedure – continue NOAC or bridging therapy (consult physician)
Moderate thromboembolic risk / high bleeding risk procedure – if normal renal function (stop 2 days prior); if poor renal function (stop 4 days prior)
Moderate thromboembolic risk / moderate bleeding risk procedure – stop 1 day before
If concern regarding stopping medication, consult with physicans.
Patel R, Charles S, Jalil A. Antiplatelets and anticoagulants in vitreoretinal surgery, with a special emphasis on novel anticoagulants: a national survey and review. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2017 Jul;255(7):1275-1285.