Department of Ophthalmology, University Hospital, Dijon, France.
Eye and Nutrition Research Group, National Scientific Research Council (CNRS), National Institute of Agronomic Research (INRA), University of Burgundy, Dijon, France.
Acta Ophthalmol. 2020 Dec;98(8):e991-e997. doi: 10.1111/aos.14434. Epub 2020 Apr 12.
To compare the risk of haemorrhagic complications in elective macular surgery between patients with no antithrombotic (AT) treatment (defined as patients with no history of AT therapy or who discontinued AT therapy) and patients who continued AT treatment during the surgery.
E-case report forms were prospectively recorded in a database before vitreoretinal surgery and 1 month after. Data on patient characteristics, surgical techniques, haemorrhagic complications and antithrombotic status were collected. Patients with retinal detachment, proliferative diabetic retinopathy and previous retinal haemorrhage were excluded.
A total of 748 procedures (single procedure in one eye per patient) were performed between January and May 2019. Among them, 202 patients (27.0%) were treated with antithrombotic therapy at the time of surgery: 19.5% with antiplatelet agents (n = 146), 6.3% with anticoagulants (n = 47) including 3.2% (n = 24) patients treated with novel oral anticoagulants, 0.8% (n = 6) with anticoagulants and antiplatelet agents, and 0.4% (n = 3) with heparin. Overall, 92 patients (12.3%) developed one or more haemorrhagic complications, of which 63 (11.5%) and 29 (14.4%) were in the non-AT and AT group, respectively. The multivariate logistic regression model showed no difference between AT treatment groups regarding ocular bleeding complications (odds ratio [OR] 1.2, 95% confidence interval (CI) [0.7-2.2], p = 0.54).
No cases of uncontrolled or severe perioperative haemorrhage in patients continuing antithrombotic agents were reported in this selected population. For the majority of the patients taking antiplatelets or anticoagulants, these agents could be safely continued during macular surgery.
比较行择期黄斑手术的患者中，无抗血栓治疗（定义为无抗血栓治疗史或已停用抗血栓治疗的患者）与手术期间继续抗血栓治疗的患者发生出血并发症的风险。
在玻璃体视网膜手术前和术后 1 个月，前瞻性地在数据库中记录电子病例报告表。收集患者特征、手术技术、出血并发症和抗血栓状态的数据。排除视网膜脱离、增殖性糖尿病视网膜病变和先前视网膜出血的患者。
2019 年 1 月至 5 月期间共进行了 748 例手术（每位患者单眼单次手术）。其中，202 例（27.0%）患者在手术时接受抗血栓治疗：19.5%接受抗血小板药物（n=146），6.3%接受抗凝剂（n=47），包括 3.2%（n=24）接受新型口服抗凝剂，0.8%（n=6）接受抗凝和抗血小板药物，0.4%（n=3）接受肝素。总体而言，92 例（12.3%）患者发生了 1 次或多次出血并发症，其中非抗血栓治疗组 63 例（11.5%），抗血栓治疗组 29 例（14.4%）。多变量逻辑回归模型显示，抗血栓治疗组之间眼部出血并发症无差异（比值比[OR]1.2，95%置信区间[CI] [0.7-2.2]，p=0.54）。
在这个选择的人群中，没有报告继续使用抗血栓药物的患者出现无法控制或严重围手术期出血的情况。对于大多数服用抗血小板或抗凝药物的患者，这些药物可在黄斑手术期间安全使用。
