Comparison of Hemorrhagic Complications of Warfarin and Clopidogrel Bisulfate in 25-Gauge Vitrectomy versus a Control Group

• Published in: Ophthalmology (Rochester, Minn.) Vol. 118; no. 3; pp. 543 - 547
• Main Authors: Mason, John O., MD, Gupta, Shelly R., MD, Compton, Christopher J., MD, Frederick, Paul A., BS, Neimkin, Michael G., BS, Hill, Mark L., BS, Heersink, Mila J., BS, Vail, Rachel S., COT, White, Milton F., MD, Feist, Richard M., MD, Thomley, Martin L., MD, Albert, Michael A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2011; Elsevier
• Subjects: Aged; Anticoagulants - administration & dosage; Biological and medical sciences; Cardiovascular Diseases - drug therapy; Choroid Hemorrhage - diagnosis; Choroid Hemorrhage - etiology; Humans; Incidence; Intraocular Pressure - physiology; Intraoperative Complications; Medical sciences; Microsurgery; Middle Aged; Miscellaneous; Ophthalmology; Platelet Aggregation Inhibitors - administration & dosage; Postoperative Complications; Retinal Diseases - surgery; Retrobulbar Hemorrhage - diagnosis; Retrobulbar Hemorrhage - etiology; Retrospective Studies; Risk Factors; Ticlopidine - administration & dosage; Ticlopidine - analogs & derivatives; Visual Acuity - physiology; Vitrectomy - adverse effects; Vitreous Hemorrhage - diagnosis; Vitreous Hemorrhage - etiology; Warfarin - administration & dosage; Warfarin; Coumarine derivatives; Anticoagulant; Hemorrhage; Antiplatelet agent; Antivitamin K; Treatment; Surgery; Antithrombotic agent; Clopidogrel; Complication; Vitrectomy; Ophthalmology; Thienopyridine derivative; Comparative study
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2010.07.005

Purpose To estimate the risk of hemorrhagic complications associated with 25-gauge pars plana vitrectomy (PPV) when warfarin (Coumadin; Bristol-Myers Squibb, New York, NY) or clopidogrel (Plavix; Bristol-Myers Squibb) are continued throughout the surgical period, as compared with a control group. Design A single-center, retrospective, cohort study of 289 consecutive patients receiving either warfarin therapy or clopidogrel therapy or neither of those therapies who underwent 25-gauge PPV. Participants Included were 61 patients (64 eyes; 64 PPV procedures) in the warfarin group and 118 (125 eyes; 136 PPV procedures) in the clopidogrel group. Warfarin patients were subdivided into 4 groups by international normalized ratio (INR). A control group included 110 patients (110 eyes; 110 PPV procedures) who were not receiving warfarin or clopidogrel. Methods Retrospective chart review for which the criteria included: 25-gauge PPV, minimum age of 19 years, warfarin or clopidogrel use, and, if taking warfarin, an INR obtained within 5 days of surgery. Main Outcome Measures Incidence of intraoperative and postoperative hemorrhagic complications. Results The most common indications for anticoagulation therapy included: atrial fibrillation (38%), valvular heart disease (17%), and thromboembolic disease (16%). The most common indications for antiplatelet therapy included: cardiac stent (49%), coronary artery bypass grafting (24%), and history of transient ischemic attack (16%). No patient experienced anesthesia-related hemorrhagic complications resulting from peribulbar or retrobulbar block. Transient vitreous hemorrhage occurred in 1 (1.6%) of 64 PPV procedures in the warfarin group ( P = 0.6531), 5 (3.7%) of 136 PPV procedures in the clopidogrel group ( P = 1.0), and 4 (3.6%) of 110 PPV procedures in the control group. No choroidal or retrobulbar hemorrhages occurred in any patient. Conclusions The rate of 25-gauge PPV hemorrhagic complications in patients who underwent systemic anticoagulation or who were receiving platelet inhibitor therapy is extremely low. Given the risks associated with stopping these therapies, the authors recommend that patients continue their current therapeutic regimen without cessation. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.