Anticoagulation management in patients requiring small-gauge vitreoretinal surgery: a review of the literature

Abstract

The management of the patient taking oral anticoagulants is a common clinical scenario in vitreoretinal surgery, where patients are often elderly and have multiple comorbidities. Performing surgery on anticoagulated patients has been associated in past studies with elevated risk of haemorrhagic complications, such as choroidal and vitreous haemorrhage. Over the past decade, the use of small-gauge sutureless vitrectomy technology has dramatically changed vitreoretinal surgery. In this article, the literature is reviewed for articles evaluating the risks of performing small-gauge sutureless vitrectomy surgery on anticoagulated patients, and the evidence-base regarding the best practice peri-operative management of these patients is reviewed. Overall, the risk of haemorrhagic complications is low in anticoagulated patients undergoing vitreoretinal surgery. There are, however, only a small number of studies that have evaluated the safety of performing this surgery while patients are on warfarin or other antiplatelet agents, and the number of patients in these studies is low. Until larger studies are performed, the clinical management of anticoagulated patients requiring vitreoretinal surgery must be individualised, taking into account the reason for anticoagulation and the risks of the particular indications for the surgery.