Hemorrhagic Risk of Vitreoretinal Surgery in Patients Maintained on Novel Oral Anticoagulant Therapy

In Brief Purpose: To evaluate the frequency and type of perioperative hemorrhagic complications associated with vitreoretinal surgery in patients undergoing systemic treatment with the newer anticoagulant and antiplatelet agents including rivaroxaban, apixaban, dabigatran, and prasugrel. Methods: Retrospective review of a cohort of patients being treated with anticoagulant and antiplatelet drugs, who underwent any vitreoretinal surgical procedure over a 2-year period. Results: Thirty-six eyes of 33 patients were identified who underwent vitreoretinal surgical operations while being treated systemically with anticoagulant and antiplatelet therapy. No eyes suffered perioperative complications of retrobulbar hemorrhage, suprachoroidal hemorrhage, or subretinal hemorrhage. Four eyes (11.1%) experienced postoperative vitreous cavity hemorrhage after which two eyes (5.5%) required repeat surgical intervention and two eyes (5.5%) cleared spontaneously. Conclusion: Although there is a relative risk to such surgery in patients who are taking novel oral anticoagulants, these findings suggest that patients may safely undergo vitreoretinal surgery while maintaining therapy with rivaroxaban, apixaban, dabigatran, and prasugrel. This report describes the frequency and types of perioperative hemorrhagic complications occurring in patients undergoing vitreoretinal surgery while on therapy with newer anticoagulant medications. None of the authors' patients experienced intraoperative hemorrhagic complications.