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Ophthalmologe. 2018 Jul;115(7):585-591. doi: 10.1007/s00347-018-0732-y.

[Management of anticoagulants in ophthalmic surgery-a survey among ophthalmic surgeons in Germany].

[Article in German]

Author information

1
Klinik für Augenheilkunde, Universitätsklinikum Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland. nicolas.feltgen@med.uni-goettingen.de.
2
DOG Geschäftsstelle, Platenstr. 1, 80336, München, Deutschland.
3
Klinik für Augenheilkunde, Universitätsklinikum Köln, Köln, Deutschland.
4
Augenklinik am Wittenbergplatz, Berlin, Deutschland.
5
Klinik für Augenheilkunde, Universitätsklinikum Essen, Essen, Deutschland.
6
Augenarztpraxis am Elsterplatz, Berlin, Deutschland.
7
St. Franziskus-Hospital Münster, Münster, Deutschland.
8
Klinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland.
9
Klinik für Augenheilkunde, Universitätsklinikum Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
10
Klinik für Augenheilkunde, Universitätsklinikum Mainz, Mainz, Deutschland.
11
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland.
12
Gerinnungszentrum Berlin Dr. Sucker, Berlin, Deutschland.
13
Augenklinik, Asklepios Klinik Barmbek, Hamburg, Deutschland.
14
Klinik für Augenheilkunde, Universitätsklinikum Greifswald, Greifswald, Deutschland.
15
Klinik für Augenheilkunde, Universitätsklinikum München, LMU, München, Deutschland.
16
Klinik für Augenheilkunde, Universitätsklinikum Aachen, Aachen, Deutschland.
17
Gerinnungsambulanz und Hämophiliezentrum an der Charité, Berlin, Deutschland.

Abstract

INTRODUCTION:

As our population ages and comorbidities rise, ophthalmic surgeons are increasingly faced with patients on anticoagulant therapy or with clotting disorders. The ophthalmic surgeon has to weigh the perioperative risk of haemorrhage when anticoagulation continues against the risk of thromboembolism caused by discontinuation or changing the patient's medication (bridging, switching, cessation). There are currently no guidelines or recommendations.

METHODS:

A survey was sent to the DOG (German Ophthalmologic Society) divisions and associated surgical organizations to determine the status quo. A questionnaire was sent out and filled out by the different groups of specialists.

RESULTS:

All four divisions of the DOG and four associated organizations returned completed questionnaires. Surgical interventions were listed that are carried out during anticoagulant therapy without exceptions, as well as interventions that were classified to require medical adjustment. Although the assessments varied, general consensus was achieved regarding interventions not requiring adjustments due to anticoagulants (i. e., intravitreal injection, cataract surgery, laser and corneal operations, simple muscle surgery), and those interventions requiring adjustments in medications (glaucoma operations, complex retina surgery, eye socket surgery, complex surgery of the lid).

CONCLUSION:

Main result of this survey was the specification of serious bleeding complications which are permanent vision loss and re-operation. They could serve as endpoint parameters for essential future investigations. Nevertheless, this survey makes clear that the decision about an adjustment of anticoagulant medication in ophthalmic surgery is currently made individually and not based on established standards.

KEYWORDS:

Aspirin; Haemorrhage; Non-vitamin K‑dependent oral anticoagulants (NOAK); Phenprocoumon; Warfarin

PMID:
29770858
DOI:
10.1007/s00347-018-0732-y
[Indexed for MEDLINE]

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