Blood Sample

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.


Anticoagulant (warfarin):

  • 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.


Reference:

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.