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Thrombozytenaggregationshemmer und Antikoagulantien bei augenchirurgischen Eingriffen

Platelet aggregation inhibitors and anticoagulants during ophthalmic interventions

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Zusammenfassung

In der Augenheilkunde werden viele Patienten operativ versorgt, die aufgrund vaskulärer Erkrankungen blutgerinnungshemmende Medikamente einnehmen müssen. Der richtige Umgang mit diesen Medikamenten setzt voraus, dass die an der Behandlung beteiligten Ärzte das thromboembolische Risiko dem operationsbedingten Blutungsrisiko richtig gegenüberstellen. Während es für die Einschätzung des thromboembolischen Risikos klare Empfehlungen auf der Basis umfangreicher Daten aus randomisierten Studien gibt, ist die Datenlage zur Beurteilung ophthalmochirurgischer Komplikationen dürftig. Im Vergleich zu anderen chirurgischen Eingriffen handelt es sich bei Augenoperationen um Eingriffe mit einem geringen Blutungsrisiko. Somit müssten gerinnungshemmende Medikamente nur selten um- oder abgesetzt werden. Im klinischen Alltag gibt es oft keine einheitliche Vorgehensweise in diesem Sinne. In diesem Beitrag soll das für den Augenarzt relevante Wissen über den perioperativen Umgang mit gerinnungshemmenden Medikamenten dargestellt werden. Außerdem werden die in der Literatur beschriebenen Daten der Blutungskomplikationen bei augenärztlichen Eingriffen aufgeführt und diskutiert.

Abstract

In ophthalmology many patients undergo surgical treatment who need to take anticoagulant medication due to cardiovascular diseases. The proper handling of these drugs requires both correct assessment of the risk of thromboembolism as well as the rating of the risk of surgery-related hemorrhages. While there are established recommendations for estimation of the risk of thromboembolism based on a large body of prospective randomized trials, data regarding the evaluation of the related complications secondary to ophthalmic surgery are limited. In comparison to other surgical procedures, most interventions in ophthalmic surgery tend to have a relatively low risk of bleeding; therefore, in general there is no need to convert or discontinue anticoagulant drugs in patients undergoing opthalmic surgery. The sparse data available justifying the abrupt termination of anticoagulation are contrary to the approach currently widely distributed in clinical practice. This overview covers the relevant knowledge of the perioperative use of anticoagulant drugs. In addition, the data on the risk of hemorrhage in ophthalmological procedures are presented and discussed.

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Authors and Affiliations

  1. Universitäts-Augenklinik, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    N. Feltgen & H. Hoerauf

  2. Augenklinik, Städtisches Klinikum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Brandenburg, Deutschland

    W. Noske

  3. Augenklinik Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    A. Hager

  4. Ambulantes Gesundheitszentrum (AGZ), Gerinnungsambulanz mit Hämophiliezentrum, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    J. Koscielny

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Feltgen, N., Hoerauf, H., Noske, W. et al. Thrombozytenaggregationshemmer und Antikoagulantien bei augenchirurgischen Eingriffen. Ophthalmologe 113, 1010–1022 (2016). https://doi.org/10.1007/s00347-016-0368-8

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