Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri 63110, USA.
Ophthalmic Plast Reconstr Surg. 2013 Mar-Apr;29(2):113-7. doi: 10.1097/IOP.0b013e31827f599e.
This study was performed to ascertain the incidence of anticoagulant use in oculoplastic surgical patients and the reliability of patient medication disclosure. Differences in perioperative bleeding complications among patients continuing anticoagulants, those who withheld the medications, and those not anticoagulated were investigated.
Following institutional review board approval, a retrospective chart review was conducted (January 1, 2008, to June 30, 2010). Anticoagulant medications and their management during the perioperative period were reviewed. Type of surgical procedure and perioperative complications were documented.
Charts were reviewed for 1130 surgeries in 1015 patients. Eighteen percent of patients failed to accurately disclose their medication use. Aspirin use was not reported in 12% of patients. There were no intraoperative complications and a single postoperative orbital hematoma among 682 patients not using anticoagulants. There were 3 intraoperative complications and 1 postoperative hemorrhage in the 207 patients whose anticoagulants were withheld. In the 145 patients who continued their anticoagulation therapy throughout the surgical period, there were no intraoperative bleeding complications, and one postoperative hemorrhage. None of the study patients sustained permanent visual deficit or deformity related to hemorrhage.
Forty percent of patients undergoing oculoplastic procedures were using anticoagulants; yet, many patients failed to disclose their medication usage. The decision to operate and whether to discontinue these medications must be individualized considering the nature of the procedure and the patient's medical condition. It may be appropriate to continue anticoagulants in certain patients at increased risk for a vascular event, ensuring adequate hemostasis throughout the procedure.
本研究旨在确定眼整形手术患者使用抗凝剂的发生率以及患者用药披露的可靠性。调查继续使用抗凝剂、停药和未抗凝的患者在围手术期出血并发症方面的差异。
在机构审查委员会批准后，进行了回顾性图表审查（2008 年 1 月 1 日至 2010 年 6 月 30 日）。审查了围手术期抗凝药物及其管理情况。记录了手术类型和围手术期并发症。
对 1015 名患者的 1130 例手术进行了图表审查。18%的患者未能准确披露其用药情况。12%的患者未报告使用阿司匹林。在未使用抗凝剂的 682 名患者中，无术中并发症，1 名患者发生术后眶血肿。在 207 名停药的患者中，有 3 例术中并发症和 1 例术后出血。在整个手术期间继续使用抗凝剂的 145 名患者中，无术中出血并发症，1 例发生术后出血。研究患者均未因出血而导致永久性视力丧失或与出血相关的畸形。
40%接受眼整形手术的患者正在使用抗凝剂；然而，许多患者未能披露其用药情况。必须根据手术性质和患者的身体状况，个体化决定是否进行手术以及是否停用这些药物。对于某些有血管事件风险增加的患者，继续使用抗凝剂可能是合适的，确保整个手术过程中充分止血。
