Risk Factors for Severe Bleeding Complications in Glaucoma Surgery and the Role of Antiplatelet or Anticoagulant Agents

Abstract

Peer Lauermann,1 Anthea Klingelhöfer,1 Dorothee Mielke,2 Dirk Bahlmann,1 Hans Hoerauf,1 Juergen Koscielny,3 Christoph Sucker,4 Nicolas Feltgen,1 Christian van Oterendorp1 1Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany; 2Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany; 3Gerinnungsambulanz mit Hämophiliezentrum im Ambulanten Gesundheitszentrum (AGZ), Charité Universitätsmedizin Berlin, Berlin, Germany; 4COAGUMED Coagulation Center, Berlin, GermanyCorrespondence: Peer Lauermann, Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch Str. 40, Goettingen, 37075, Germany, Email [email protected]: To evaluate the influences and risk factors for severe bleeding complications during glaucoma surgery, and to investigate the role of antiplatelet (AP) and anticoagulant (AC) agents.Methods: This prospective study enrolled patients undergoing trabeculectomy, trabeculotomy (with Trabectome® or Kahook Dual Blade®), viscocanaloplasty and Ahmed or Baerveldt implants. Bleeding severity was graded on an ordinal scale ranging from 0 to 5. Immediately after surgery and one day later, the incidence and severity of bleeding events was documented on a standardized form. A grade ≥ 3 was defined as severe bleeding. The influence of known systemic disorders, the type of anesthesia, surgical procedure, intraoperative blood pressure, and the use of or change in AP or AC agents on intraoperative bleeding were analyzed.Results: Data from 89 eyes undergoing glaucoma procedures were included (age 71.3y ± 10.5). We observed severe intraoperative bleeding in 8 eyes (9%) and found that concomitant diseases such as the history of a deep vein thrombosis or peripheral arterial occlusive disease, and the type of surgical procedure (trabeculectomy and viscocanaloplasty) were significantly associated with severe bleeding events. By contrast, the use of AP/ AC agents had no significant influence on severe intraoperative bleeding events.Conclusion: According to the results of our study cohort, glaucoma procedures entailing scleral manipulations (trabeculectomy and viscocanaloplasty) and concomitant diseases such as the history of a deep vein thrombosis or peripheral arterial occlusive disease influence the risk of severe intraoperative bleeding events, we detected no increased risk related to concomitant antiplatelet and/ or anticoagulant medication use.Keywords: glaucoma surgery, severe bleeding complications, antiplatelet agents, anticoagulant agents

Keywords

• glaucoma surgery – severe bleeding complications – antiplatelet agents – anticoagulant agents