The effect of aspirin and warfarin therapy in trabeculectomy

doi:doi:10.1038/sj.eye.6702277

Eye (2007) 21, 598–603. doi:10.1038/sj.eye.6702277; published online 3 March 2006

The effect of aspirin and warfarin therapy in trabeculectomy

We have no proprietary interests in any of the products mentioned in the manuscript. No funding was obtained for this study

C J Cobb¹, S Chakrabarti¹, V Chadha² and R Sanders²

¹Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, UK
²Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, UK

Correspondence: V Chadha, 11 West Holmes Place, Broxburn, West Lothian EH 52 5NJ, UK Tel: +44 786 508 1415; E-mail: vchdh@aol.com

Received 20 June 2005; Accepted 23 December 2005; Published online 3 March 2006.

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Abstract

Aim

The management of patients on antiplatelet and anticoagulation therapy (APACT) in glaucoma surgery currently has no specific recommendations. We aimed to establish the risk of haemorrhagic complications and surgical outcome in patients on APACT in glaucoma surgery.

Methods

We retrospectively examined 367 consecutive trabeculectomies performed between 1994 and 1998. Preoperatively 60 (16.4%) patients were on APACT (55 on aspirin and five on warfarin). The incidence of hyphaema and haemorrhagic complications between patients with and without APACT was documented. Surgical success was defined in two categories as an intraocular pressure (IOP) <21 mmHg and an IOP <16 mmHg 2 years following trabeculectomy with and without antiglaucoma medication.

Results

None of the patients on aspirin suffered significant intra or postoperative haemorrhage. Aspirin was associated with a significantly higher risk of hyphaema (P=0.0015) but this was not found to significantly affect IOP control at 2 years. Patients on warfarin suffered haemorrhagic complications and trabeculectomy failure.

Conclusions

Aspirin appears to be safe to continue with during trabeculectomy. Patients on aspirin have an increased risk of hyphaema following trabeculectomy. This however does not appear to affect surgical outcome. Warfarinised patients are at risk of serious bleeding complications. They require careful monitoring pre- and postoperatively and are at risk of trabeculectomy failure.