Risk of Hemorrhage during Needle-Based Ophthalmic Regional Anesthesia in Patients Taking Antithrombotics: A Systematic Review

Autor: Patricia Marchioro, Graziela De Luca Canto, Luis André Mezzomo, Augusto Key Karazawa Takaschima, Thiago Mamôru Sakae, André Luís Porporatti
Rok vydání: 2016
Předmět:
medicine.medical_specialty
MEDLINE
lcsh:Medicine
Hemorrhage
Surgical and Invasive Medical Procedures
Ophthalmologic Surgical Procedures
030204 cardiovascular system & hematology
Pathology and Laboratory Medicine
Antiplatelet Therapy
Research and Analysis Methods
Vascular Medicine
Database and Informatics Methods
03 medical and health sciences
Signs and Symptoms
0302 clinical medicine
Fibrinolytic Agents
Drug Therapy
Anesthesiology
Internal medicine
Antithrombotic
Medicine and Health Sciences
medicine
Humans
Anesthesia
Database Searching
lcsh:Science
Intensive care medicine
Retrospective Studies
Aspirin
Multidisciplinary
Pharmaceutics
business.industry
lcsh:R
Ophthalmic Procedures
Warfarin
Cataract Surgery
Retrospective cohort study
Clopidogrel
Confidence interval
030221 ophthalmology & optometry
lcsh:Q
Local and Regional Anesthesia
business
Fibrinolytic agent
Anesthesia
Local
Research Article
medicine.drug
Zdroj: PLoS ONE
PLoS ONE, Vol 11, Iss 1, p e0147227 (2016)
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0147227
Popis: Background Patients undergoing ophthalmic surgery are usually elderly and, due to systemic disease, may be on long-term therapy, such as antithrombotic agents. Rates of hemorrhagic complications associated with invasive procedures may be increased by the use of anticoagulants and antiplatelet agents. Objective To compare the incidence of hemorrhagic complications in patients undergoing needle-based ophthalmic regional anesthesia between patients on antithrombotic therapy and those not on such therapy. Methods A systematic review was conducted by two independent reviewers based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the “gray” literature (Google Scholar). The end search date was May 8, 2015, across all databases. Results Five studies met the eligibility criteria. In three studies, individual risk of bias was low, and in two of them, moderate. In all studies, no differences regarding mild to moderate incidence of hemorrhagic complications were found between patients using antithrombotics (aspirin, clopidogrel, and warfarin) and those not using them. Rates of severe hemorrhagic complication were very low (0.04%) in both groups, supporting the safety of needle blocks, even in patients using antithrombotics. High heterogeneity across studies prevented meta-analysis. Limitations to these results include low statistical power in three experimental studies and a large 95% confidence interval in the two retrospective cohorts. Conclusion In this review, none of the selected studies showed significant bleeding related to needle-based ophthalmic regional anesthesia in association with the use of aspirin, clopidogrel, or vitamin K inhibitors. Since the available data is not powerful enough to provide a reliable evaluation of the true effect of antithrombotics in this setting, new studies to address these limitations are necessary.
Databáze: OpenAIRE
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