Loco-regional anaesthesia for ocular surgery: Anticoagulant and antiplatelet drugs

Abstract

Many patients undergoing ophthalmic surgery have significant co-morbidity. Many take anticoagulant or antiplatelet drugs. Stopping these drugs in patients with heart or vascular disease may result in death from a thromboembolic episode. The risk of this must be balanced against the risk of bleeding. In general, the risks of stopping these drugs outweigh the risks of ophthalmic surgery, which is in most cases confined to the eye. The majority of eye surgery is now performed under local anaesthesia (LA). There is no strong evidence currently to favour blunt cannula techniques such as sub-Tenon’s block over traditional sharp needle peribulbar block in patients on anticoagulant or antiplatelet therapy. Most studies are too small to detect a significant difference when comparing patients on anticoagulant or antiplatelet medication with those that are not, but the incidence of significant sight threatening haemorrhagic complications appears to be very low for cataract surgery, of the order of 3 per 10,000 operations.

There is some concern that drug and food interactions may affect anticoagulation with warfarin and it is recommended that the International Normalized Ratio (INR) be measured as close to the time of operation as possible.

Conclusions reached for ambulatory cataract surgery may not apply to more invasive and complex operations.