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<bold>Dimosthenis Mantopoulos, MD,</bold> can be reached at the Department of Ophthalmology, Ohio State University; Havener Eye Institute; 915 Olantangy River Road, Columbus, OH 43212; email: <email xlink:type="simple">[email protected].
<bold>Demetrios G. Vavvas, MD, PhD,</bold> can be reached at the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114; email: <email xlink:type="simple">[email protected].
<bold>Howard F. Fine, MD, MHSc,</bold> can be reached at the Department of Ophthalmology, Rutgers University of Medicine and Dentistry of New Jersey; NJ Retina; 10 Plum Street, Suite 600; New Brunswick, NJ 08901; email: <email xlink:type="simple">[email protected].
<bold>Disclosures:</bold> Dr. Fine is a consultant and/or speaker for Alimera, Allergan, Genentech, Regeneron, and Spark Therapeutics and has equity/patent interests in Auris Surgical Robotics. The remaining authors report no relevant financial disclosures.
Howard F. Fine, Practical Retina Co-Editor
Incorporating current trials and technology into clinical practice
A multitude of new anticoagulant and antiplatelet agents have been introduced Although some of these agents are pharmacologically reversible, many are not. The site of metabolism and half-life differs by agent, so discontinuation parameters can vary widely.
Many of our cataract surgical colleagues ignore systemic anticoagulation with impunity. After all, cataract surgery is typically a bloodless procedure. Modern transconjunctival vitreoretinal surgery, particularly macular cases including epiretinal membranes and macular holes, are much less invasive than in the past. Yet other vitreoretinal procedures, such as scleral buckling or vitrectomy for diabetic tractional retinal detachment, can have dire consequences with significant bleeding. Evidence-based guidance is needed.
In this edition of Practical Retina, Dimosthenis Mantopoulos, MD, from Ohio State University, and Demetrios G. Vavvas, MD, PhD, from the Massachusetts Eye and Ear Infirmary, provide a roadmap for the vitreoretinal surgeon to navigate the new landscape of anticoagulant and antiplatelet agents. They provide a handy guide regarding the metabolism and discontinuation parameters for these medications and delve into the available literature regarding their use and risks during ophthalmic surgery.
Vitreoretinal surgeons are frequently faced with the preoperative decision of whether to hold an anticoagulant or antiplatelet agent. In collaboration with the patient's primary medical team, the surgeon must balance the urgency of the case, the likelihood of intraoperative hemorrhage, and the systemic risks to holding the medication. Therefore, this review by Drs. Mantopoulos and Vavvas is sure to be of high interest...