Türk oftalmologların antikoagülan/antiagregan tedavisi alan hastalara preoperatif yaklaşımı: bir anket çalışması

Amaç: Bu çalışmanın amacı, oftalmologların antikoagülan/antiagregan ilaçlar hakkındaki bilgilerini güncellemektir.Gereç ve Yöntem: Antikoagülan/antiagregan ilaçlar ve bu ajanların perioperatif yönetimi hakkındaki bilgileri araştıran bir anket 106 oftalmolog tarafından cevaplandı.Bulgular: Katılımcıların 19'u (%17,9) asistan, 69'u (%65,1) uzman, 18'i (%17) akademisyen olup; %47,2'si 10 yıldan beri oftalmoloji alanında hizmet vermektedir.Elli sekiz (%54,7) katılımcının bu ilaçlar hakkında bir eğitim aldığı, 78 (%73,5) katılımcının antikoagülan/antiagregan ajanların ayırt edilebilmesinin yanı sıra; konuyla ilgili terimler hakkında da bilgi sahibi olduğu görüldü. Hekimler arasında eğitim alma ve ilaçların tanınması açısından fark yoktu (sırasıyla, p=0,970, p=0,948). Katılımcıların %10,4'ü 6 veya daha fazla ilacı, %48,1'i 4-6 arası ilacı, %41,5'i 1-3 arası ilacı biliyordu.Perioperatif ilaç yönetimi göz önüne alındığında, 52 (%49,1) hekimin ilaç tedavisinin kesilmesini, 24 (%22,6) hekimin ise ilaç kullanımının devamını önerdiği görüldü. İlaç kesilme oranları; üniversite hastaneleri ve eğitim ve araştırma hastanelerinde, kamu hastaneleri ve özel hastanelere kıyasla daha yüksek bulundu (p=0,03).Sonuç: Antikoagülan/antiagregan ilaçlar ve bu ajanların perioperatif yönetimleri hakkındaki bilgilerin bilinmesi komplikasyonların önlemesi açısından esastır. Bu nedenle; bu ilaçlar ve ilaçlarla tedavi edilen hastalarla ilgili oftalmoloji kliniklerinde uygulanacak düzenli eğitim, bu konudaki farkındalığı artırabilir.

Anahtar Kelimeler:

Oftalmolojist, antikoagülan/antiagregan, hemorajik komplikasyon, perioperatif yönetim

The preoperative approach of Turkish ophthalmologists concerning anticoagulant/antiaggregant therapy: a questionnaire study

Purpose: The aim of the study was to update the information about anticoagulant/antiaggregant drugs for ophthalmologists.Materials and Methods: A questionnaire investigating the information about anticoagulant/antiaggregant drugs and perioperative management of these agents was answered by 106 ophthalmologists.Results: The participants included residents by 19 (17.9%), specialists by 69 (65.1%), academic members by 18 (17%); 47.2% of the participants have been serving in ophthalmology field for ≥10 years. It was detected that 58 (54.7%) participants were trained about these drugs; and 78 (73.5%) participants have knowledge on terms as well as differentiation of anticoagulant/antiaggregant agents. There was not any difference between the physicians in terms of training and drug differentiation (p=0.970, p=0.948, respectively). Six or more preparations were known by 10.4% of the participants whereas 4 to 6 preparations were known by 48.1% of the participants and 1 to 3 preparations were known by 41.5% of the participants. In consideration of perioperative drug management, it was determined that 52 (49.1%) physicians recommend discontinuation of the medications whereas 24 (22.6%) physicians suggest continuation of drug use. The rates for drug discontinuation were found higher in university hospitals as well as training and research hospitals when compared with public hospitals and private hospitals (p=0.03).Conclusion: Information on anticoagulant/antiaggregant agents as well as perioperative management is essential to prevent complications. Therefore, training in ophthalmology clinics where the patients who are treated with aforesaid drugs may increase the awareness on this issue.

Keywords:

Ophthalmologist, anticoagulant/antiaggregant, hemorrhagic complication, perioperative management,

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1- United States Department of Health and Human Services. Administration on Aging, Administration for Community Living. A profile of Older Americans 2017:16. https://acl.gov/aging-and-disability-in-america/data-and-research/profile-older-americans Accessed April 2018.
2- Afshari A, Ageno W, Ahmed A et al. ESA VTE Guidelines Task Force. European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary. Eur J Anaesthesiol 2018;35:77-83. 3- Levine MN, Raskob G, Beyth RJ, Kearon C, Schulman S. Hemorrhagic complications of anticoagulant treatment. The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004;126:287S-310S.
4- Demir M, Tekgündüz E. Antithrombotic and anticoagulant usage policies. Trakya Univ Tip Fak Derg 2010;27:69-73.
5- Karadağ B, İkitimur B, Öngen Z. Perioperative management in patients receiving newer oral anticoagulant and antiaggregant agents. Arch Turk Soc Cardiol 2012,40:548-551.
6- Barequet IS, Sachs D, Priel A et al. Phacoemulsification of cataract in patients receiving coumadin therapy: ocular and hematologic risk assessment. Am J Ophthalmol 2007;144:719-723.
7- Law SK, Song BJ, Yu F, Kurbanyan K, Yang TA, Caprioli J. Hemorrhagic complications from glaucoma surgery in patients on anticoagulation therapy or antiplatelet therapy. Am J Ophthalmol 2008;145:736-746.
8- Brown JS, Mahmoud TH. Anticoagulation and clinically significant postoperative vitreous hemorrhage in diabetic vitrectomy. Retina 2011;31:1983-1987.
9- Aktürk İF, Çağlar FN, Keskin K et al. Approach of Turkish dentists concerning patients with coronary stents and dual antiplatelet therapy. İstanbul Med J 2014;15:47-49.
10- Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth edition). Reg Anesth Pain Med 2018,43:263-309.
11- Rosencher N, Bonnet MP, Sessler DI. Selected new antithrombotic agents and neuraxial anaesthesia for major orthopaedic surgery: management strategies. Anaesthesia 2007;62:1154-1160.
12- Kuhli-Hattenbach C, Fischer IB, Schalnus R, Hattenbach LO. Subretinal hemorrhages associated with age-related macular degeneration in patients receiving anticoagulation or antiplatelet therapy. Am J Ophthalmol 2010;149:316-321.
13- Kiernan DF, Hariprasad SM, Rusu IM, Mehta SV, Mieler WF, Jager RD. Epidemiology of the association between anticoagulants and intraocular hemorrhage in patients with neovascular age-related macular degeneration. Retina 2010;30:1573-1578.
14- Knox FA, Johnston PB. Spontaneous suprachoroidal haemorrhage in a patient with age-related macular degeneration on excessive anticoagulation therapy. Eye (Lond) 2002;16:669-670.
15- Ying GS, Maguire MG, Daniel E, Grunwald JE, Ahmed O, Martin DF. Comparison of Age-Related Macular Degeneration Treatments Trials Research Group. Association between antiplatelet or anticoagulant drugs and retinal or subretinal hemorrhage in the comparison of age-related macular degeneration treatments trials. Ophthalmology 2016;123:352-360.
16- Olson JM, Scott IU, Kerchner DL, Kunselman AR. Association between systemic anticoagulation and rate of intraocular hemorrhage following intravitreal anti-VEGF therapy for age-related macular degeneration. Opthalmic Surg Lasers Imaging Retina 2013;44:455-459.
17- Akkan Aydoğmuş FS, Serdar K, Kalaycı D, Çelik A. Spontaneous suprachoroidal hemorrhage associated with iatrogenic coagulopathy. Retin Cases Brief Rep 2019;13:174-175.