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Abstract #21007 Published in IGR 10-2
Anticoagulation therapy in glaucoma surgery
Alwitry A; King AJ; Vernon SAGraefe's Archive for Clinical and Experimental Ophthalmology 2008; 246: 891-896
See also comment(s) by Jay Katz •
PURPOSE: To identify the practices of ophthalmologists when undertaking glaucoma surgery on patients concurrently using warfarin or acetylsalicylic acid (aspirin). METHODS: A questionnaire was designed to examine perioperative management of patients being treated with warfarin and aspirin prior to and during glaucoma surgery. The questionnaire was posted with stamped self-addressed envelopes to all glaucoma specialists registered on a glaucoma shared care scheme database. RESULTS: Of the 93 eligible participants, 64 returned a completed questionnaire, representing a response rate of 68.8%. Twenty-one surgeons (32.8%) routinely stopped warfarin before surgery. Mean time prior to surgery of drug cessation was 4 days (range 2-7). Three surgeons (14.3%) routinely commenced heparin if they stopped warfarin. Ten (47.6%) never used heparin, while the remaining eight (38.1%) would use heparin depending upon the indication for anticoagulation. Forty-two surgeons (81.25%) were happy to operate only at an INR ≤ 3 at the time of surgery. The remainder (18.75%) were happy to operate at higher INRs, including two surgeons (3.1%) who would operate at any level. Twenty surgeons (31.2%) routinely stopped aspirin before surgery, while the rest did not. Of those who stopped aspirin, the mean time prior to surgery was 7.1 days (range 4-14 days). CONCLUSIONS: The majority of surgeons do not stop warfarin or aspirin prior to glaucoma surgery. There is a great diversity in current practice with regard to the management of anticoagulant therapy prior to glaucoma surgery amongst glaucoma surgeons in England. Currently there is little information available to offer definitive guidance.
Dr. A. Alwitry, Eye, Ear, Nose and Throat Centre, Queens Medical Centre, Nottingham, UK
Classification:
11.15 Other drugs in relation to glaucoma (Part of: 11 Medical treatment)