Abstract Listings 2024

Purpose

Data on ophthalmic surgical complications in patients taking direct oral anticoagulants (DOAC) is sparse. This study aimed to report on bleeding and thrombotic outcomes in patients taking DOAC undergoing oculoplastic, lacrimal, or orbital procedures.

Methods

A retrospective cohort study at a single British tertiary centre, including all patients in a 6-month period who underwent an oculoplastic, lacrimal, or orbital procedure and were taking a DOAC. Patients were identified from the pre-assessment diary. DOAC are routinely discontinued peri-operatively, per Trust protocol, except in cases of minor bleed risk. As per Trust and national guidance, continuing DOAC is made on an individual basis, according to thrombotic versus bleed risk. Procedures were graded into minor, moderate, and high risk. Thrombotic and bleeding events to 4 weeks post-operative were identified.

Results

There were 228 procedures in patients fulfilling the criteria for surgical pre-assessment. Of these, 97 cases (79 patients) were done on patients who were taking a DOAC.

DOAC were continued in 28 (29%) procedures (13 minor bleed risk, 13 moderate bleed risk, 1 high bleed risk). There were 14 (14%) bleed events overall, of which only 2 (2%) were considered severe (one intraoperative, one post0perative). Neither resulted in vision loss or death. Post-operative bleeding and overall bleed events correlated to the graded procedure bleed risk, p=0.002 and p=0.003, respectively, but intraoperative bleeding did not, p=0.13. The graded procedure bleed risk depends mainly on the procedure type (oculoplastic, orbital, lacrimal).

Thrombotic events were not identified in any of these patients, and importantly not in those where DOAC was stopped peri-operatively.

Conclusion

Bleeding, particularly post-operative bleeding correlated with the inherent bleed risk of the procedure, rather than the perioperative use of DOAC. It is likely safe to continue DOAC in oculoplastic procedures, but should be stopped for orbital procedures.

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