Preoperative management of ophthalmic patients taking oral anticoagulants

Surgical treatment is often accompanied by such complication as bleeding, and ophthalmic surgery is not an exception. The bleeding risk depends on many factors, the most significant are age, arterial hypertension, hepatic and renal impairment, prior stroke or treatment with oral anticoagulants.

The aim. To evaluate the structure of patients taking novel oral anticoagulants (NOACs) with an assessment of activated partial thromboplastin time before ophthalmosurgical treatment.

Materials and methods. 54 patients taking oral anticoagulants were included in the study. A retrospective analysis of medical histories of patients who had surgery for ocular pathology was carried out. The patients were divided into two groups: group 1 – 28 patients whose activated partial thromboplastin time (APTT) did not exceed 45 seconds; group 2 – 26 patients with APTT more than 45 seconds. The criterion for the numerical expression of APTT is the safety of performing regional anesthesia against the background of taking anticoagulant drugs. Statistical processing was performed using the Mann – Whitney test (p < 0.05).

Results. A comparative analysis of the results showed that the patients of the group 2 had higher rates of APTT. At the same time, they were less likely to have acute cerebrovascular accident (11.5 % compared to 21 % of patients in the group 2) and prior acute myocardial infarction (19 % and 28 %, respectively). Among all the patients, women and slightly older patients prevailed.

Conclusion. Patients with atrial fibrillation make up the majority of patients undergoing ophthalmosurgical treatment and taking NOACs. Surgical treatment method was phacoemulsification with intraocular lens implantation. Studying APTT before the surgery allowed us to identify a category of patients with high APTT, to prescribe the withdrawal of the drug before the surgery in order to create optimal conditions for surgical treatment.

1. Protasov KV, Fedorishina OV. Prevention of systemic embolism in patients with atrial fibrillation. Irkutsk; 2014. (In Russ.).

2. Sinkov SV, Zabolotskikh IB. Diagnosis and correction of disorders of the hemostasis system; 2nd ed., revised and corrected. Moscow: Prakticheskaya meditsina; 2017. (In Russ.).

3. Prediction and prevention of cardiac complications of non-cardiac surgical interventions. Cardiovascular Therapy and Prevention. 2011; (6S3): 3-28. (In Russ.). doi: 10.15829/17288800-2011-6S3-3-28

4. Dzhioeva ON, Orlov DO, Reznik EV, Nikitin IG, Rodoman GV. Current principles of decreasing perioperative cardial complications in extracardiac surgical interventions. Russian Medical Journal. 2018; 6(1): 33-40. (In Russ.).

5. Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK. Executive summary: regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based guidelines (third edition). Reg Anesth Pain Med. 2010; 35(1): 102-105. doi: 10.1097/AAP.0b013e3181c15dd0

6. Vílchez JA, Gallego P, Lip GY. Safety of new oral anticoagulant drugs: A perspective. Ther Adv Drug Saf. 2014; 5(1): 8-20. doi: 10.1177/2042098613507945

7. Oleshchenko IG, Zabolotsky DV, Koriachkin VA, Pogorelchuk VV. Ensuring the effectiveness and safety of peripheral blockades. Acta biomedica scientifica. 2021; 6(6-1): 105-112. (In Russ.). doi: 10.29413/ABS.2021-6.6-1.12

8. Zabolotskikh IB, Shifman EM. Clinical guidelines. Anesthesiology and reanimatology. Moscow: GEOTAR-Media; 2016. (In Russ.).

9. Zabolotskikh IB, Kirov MYu, Afonchikov VS, Bulanov AYu, Grigoriev EV, Gritsan AI, et al. Perioperative management of patients receiving long-term antithrombotic therapy. Clinical guidelines of the Federation of Anesthesiologists and Resuscitators of Russia. Moscow; 2019. (In Russ.).

10. Tagariello G, Radossi P, Salviato R, Zardo M, De Valentin L, Basso M, et al. Clinical relevance of isolated prolongation of the activated partial thromboplastin time in a cohort of adults undergoing surgical procedures. Blood Transfus. 2017; 15(6): 557561. doi: 10.2450/2016.0047-16

11. Li J, Halaszynski T. Neuraxial and peripheral nerve blocks in patients taking anticoagulant or thromboprophylactic drugs: challenges and solutions. Local Reg Anesth. 2015; 8: 21-32. doi: 10.2147/LRA.S55306

12. Ong-Tone L, Paluck EC, Hart-Mitchell RD. Perioperative use of warfarin and aspirin in cataract surgery by Canadian Society of Cataract and Refractive Surgery members: Survey. J Cataract Refract Surg. 2005; 31(5): 991-996. doi: 10.1016/j.jcrs.2004.09.058