科研之友
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摘要
PURPOSE: To evaluate changes in the prevalence of antiplatelet (aspirin, clopidogrel) and anticoagulation (warfarin) therapy and its possible relationship to postoperative bleeding in vitreoretinal surgery (VRS) patients.
DESIGN: Observational, retrospective case control study.
METHODS: SETTING: University practice. STUDY POPULATION: A total of 822 patents who underwent VRS during 3 intervals in 1994, 2004, and 2008. OBSERVATION PROCEDURE: Retrospective chart review for 1994 and 2004, but contemporaneous in 2008. MAIN OUTCOME MEASURES: Proportion using antiplatelets or anticoagulants, the incidence of early postoperative intraocular bleeding in patients, and clinical consequence of the hemorrhage.
RESULTS: Thirty-one of 213 patients (14.6%) who underwent VRS in 1994, 103 of 361 patients (28.5%) in 2004, and 80 of 248 patients (32.3%) in 2008 had taken antiplatelet therapy (P < .001). The rates of anticoagulant therapy did not vary. The incidence of bleeding was higher (20.0%) in the patients who did not suspend antiplatelets than in those who did (9.6%) (P = .05, chi(2) test), but this difference lost statistical significance in a multivariate analysis (P = .079). Anticoagulant was associated with intraocular hemorrhage at postoperative first day after vitrectomy (P = .03, Fisher exact test). No reoperation or failure of the surgery was attributable to the hemorrhage in anticoagulant or antiplatelet patients.
CONCLUSIONS: Use of antiplatelet agents has increased in patients undergoing vitreoretinal surgery but probably does not increase the risk of postoperative intraocular bleeding; however, when safe to suspend even for a short time the potential risk is further reduced. Anticoagulant use was associated with a higher risk, but without serious consequences. Working with a patient's medical doctor may allow safe suspension in some cases, which may further lower these risks. (Am J Ophthalmol 2011;151:934-939.
- 出版日期2011-6
