Aspirin and warfarin therapy in oculoplastic surgery

Background/aims-There are no nationally agreed guidelines on preoperative m anagement of patients who are on aspirin or warfarin therapy. There is cons iderable evidence that complication rates in anticoagulated patients are lo w whereas there are higher rates of thromboembolic complications in those w hose therapy is manipulated. This survey aimed to establish oculoplastic sp ecialist and nonspecialist ophthalmic surgeons' current management practice of patients before oculoplastic surgery who are taking aspirin or warfarin and to assess the rate of complications in these patients. Method-An anonymous postal questionnaire survey of all ophthalmic consultan ts and specialist registrars in the Wessex region along with oculoplastic s pecialists in the Southern region. Results-The overall response rate was 92%. Preoperative management was infl uenced both by type of operation and by type of surgeon. A statistically si gnificant higher proportion of surgeons would consider altering warfarin co mpared with aspirin treatment. For all procedures, non-specialists are unli kely to stop aspirin therapy, and are less likely to stop warfarin before a ll procedures apart from dacrocystorhinostomy. A significant proportion of surgeons (18%) would allow insufficient time for the coagulation status of the patient to change after altering treatment. A considerable proportion o f surgeons (54%) reported that they had seen complications as a result eith er of stopping or continuing anticoagulation therapy. Conclusions-In this survey, at least half the surgeons questioned would con sider stopping warfarin before oculoplastic procedures. Over half of all su rgeons have seen complications related to aspirin or warfarin, some of whic h were serious. A suggested approach to minimising patient risk is given.