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    Managing antithrombotic agents in patients scheduled for eyelid surgery

    Risk-stratification for stopping therapy should be determined by case, team of physicians

    A majority of patients undergoing ophthalmic surgery include the elderly populace who may be taking systemic medications—such as anticoagulants and antiplatelet drugs—on a regular basis. Epidemiologic studies have shown that more than 28% of this population take aspirin, 2% clopidogrel, and more than 5% take an anticoagulant.

    General anesthesia has become mostly used in the pediatric population and rarely used in the elderly. Therefore, managing antiplatelet and anticoagulant medications for procedures that require regional anesthesia is an important and increasing problem for ophthalmologists.

    To date, there are no validated guidelines for oculoplastic surgeons regarding antithrombotic agents perioperatively. Main concerns are intraoperative bleeding that may lead to functional consequences, and arterial or venous thromboembolic events that may cause severe complications.

    In cataract surgery, the preoperative management of antithrombotic agents has been well studied. However, the recommendation for other ophthalmic procedures--such as blepharoplasty--varies based on recent published studies.

    Surgeries for which a stop/bridge is required

    The aim is to identify the safest practices in the management of elective blepharoplasty between patients who may or may not be on antithrombotic therapy (ATT).

    A systemic literature review was conducted by three independent reviewers based on searches of Cochrane, Google Scholar, LILACS, PubMed, Scopus, and Web of Science. The end search date was Nov. 1, 2016, across all databases. There were no language or date restrictions in these searches.

    Identifying best practices

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