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Kishore K, Hariprasad SM, Mungee S. Perioperative Antiplatelet Agents and Anticoagulants in Vitreoretinal Surgery. Ophthalmic Surg Lasers Imaging Retina 2022; 53:71-78. [PMID: 35148217 DOI: 10.3928/23258160-20220128-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chen AF, He X, Nirwan RS, Sridhar J, Kuriyan AE. Perioperative Management of Anticoagulants in Ocular Surgeries. Int Ophthalmol Clin 2020; 60:3-15. [PMID: 32576719 PMCID: PMC7334869 DOI: 10.1097/iio.0000000000000316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Use of anticoagulant therapy has increased in patients presenting for ophthalmic surgery over the past decade. The decision of whether or not to discontinue anticoagulant medications prior to ophthalmic surgeries is nuanced and ultimately based on multiple factors including the type of surgery and the patient’s comorbidities and risk profile. In the setting of cataract surgery, no increased risk of bleeding with anticoagulation was observed in a large prospective study, which suggests that anticoagulation should not be interrupted for the average-risk patient on anticoagulation. In other types of ophthalmic surgery, expert opinion and studies are divided on the perioperative management of anticoagulant therapy. Preoperative thromboembolic risk stratification, intraoperative techniques to minimize bleeding, and postoperative management are also reviewed to generate more comprehensive recommendations on ophthalmic perioperative management of anticoagulation.
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Affiliation(s)
- Alexander F. Chen
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
| | - Xu He
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
| | - Rajinder S. Nirwan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Ajay E. Kuriyan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
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3
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Kumar CM, Seet E. Stopping antithrombotics during regional anaesthesia and eye surgery: crying wolf? Br J Anaesth 2018; 118:154-158. [PMID: 28100518 DOI: 10.1093/bja/aew404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- C M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
| | - E Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
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Sucker C, Hager A, Koscielny J, Feltgen N. [Oral anticoagulation : Current overview and perioperative management in ophthalmic surgery]. Ophthalmologe 2018; 116:144-151. [PMID: 29766263 DOI: 10.1007/s00347-018-0724-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Antithrombotic treatment with oral anticoagulants and antiplatelet agents can increase the risk for perioperative bleeding. In contrast to other surgical fields, the optimal perioperative management in ophthalmic surgery has not yet been exactly defined and, thus, is not standardized. In this contribution, we provide an overview of currently available oral anticoagulants and discuss potential strategies for the management of these agents in different ophthalmic surgical procedures.
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Affiliation(s)
- C Sucker
- Gerinnungszentrum Berlin Dr. Sucker, Tauentzienstraße 7b/c, 10789, Berlin, Deutschland.
| | - A Hager
- Gerinnungsambulanz, Charité, Berlin, Deutschland
| | - J Koscielny
- Augenarztpraxis am Elsterplatz, Kissinger Straße 1, 14199, Berlin, Deutschland
| | - N Feltgen
- Augenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Yau GL, Silva PS, Arrigg PG, Sun JK. Postoperative Complications of Pars Plana Vitrectomy for Diabetic Retinal Disease. Semin Ophthalmol 2017; 33:126-133. [PMID: 29215958 DOI: 10.1080/08820538.2017.1353832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Despite recent advances in the medical management of diabetic retinal disease, there remain established indications for vitreoretinal surgery in the treatment of severe proliferative diabetic retinopathy. These include non-clearing vitreous hemorrhage and tractional retinal detachment. Advances in surgical instrumentation, technique, and experience have led to improved visual outcomes, as well as a corresponding decrease in the incidence of postoperative complications. However, the presence of systemic and ocular factors in diabetic patients increases the risk of adverse events compared to non-diabetic individuals. This review will focus on the most important postoperative complications following pars plana vitrectomy, with specific considerations for the diabetic patient.
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Affiliation(s)
- Gary L Yau
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA
| | - Paolo S Silva
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Paul G Arrigg
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Jennifer K Sun
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
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Patel R, Charles S, Jalil A. Antiplatelets and anticoagulants in vitreoretinal surgery, with a special emphasis on novel anticoagulants: a national survey and review. Graefes Arch Clin Exp Ophthalmol 2017; 255:1275-1285. [DOI: 10.1007/s00417-017-3664-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/17/2017] [Accepted: 03/27/2017] [Indexed: 01/28/2023] Open
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Mantopoulos D, Vavvas DG, Fine HF. Perioperative Risks of Antiplatelet and Anticoagulant Drugs in Vitreoretinal Procedures. Ophthalmic Surg Lasers Imaging Retina 2017; 48:4-8. [DOI: 10.3928/23258160-20161219-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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HEMORRHAGIC RISK OF VITREORETINAL SURGERY IN PATIENTS MAINTAINED ON NOVEL ORAL ANTICOAGULANT THERAPY. Retina 2016; 36:299-304. [DOI: 10.1097/iae.0000000000000783] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PURPOSE To determine whether preoperative medical testing reduces the risk of postoperative systemic adverse events after vitreoretinal surgery. METHODS Retrospective cohort study at a single academic university hospital involving a total of 2,215 patients undergoing vitreoretinal surgery. Medical charts of 2,215 patients who underwent vitreoretinal surgery between January 2002 and November 2011 at Vanderbilt University were reviewed for baseline comorbidities, preoperative testing, type of anesthesia during surgery, and systemic adverse events occurring within 30 days after surgery. Main outcome measures were the association of baseline characteristics and preoperative testing with postoperative systemic adverse events. RESULTS Approximately a half of patients had electrolyte, renal function, and electrocardiogram evaluation. The most common comorbidities were hypertension (53%), diabetes mellitus (37%), and coronary artery disease (18%). The most common preoperative testing performed was blood glucose (58%). A total of 102 systemic adverse events occurred in 89 of 2,215 patients (4%) within the first 30 days after surgery with the majority (72%) occurring within the first 24 hours. The most common adverse event was bradycardia (34%) followed by desaturation (25%). Patients with a history of coronary artery disease, asthma, chronic renal disease, or receiving general anesthesia had a 2.04 (P = 0.01), 2.18 (P = 0.03), 2.76 (P < 0.01), and 3.72 (P < 0.001) increased odds of developing postoperative systemic adverse events, respectively. Multivariate logistic regression analysis demonstrated no significant correlation between preoperative testing and postoperative adverse events. CONCLUSION Incidence of postoperative systemic adverse events after vitreoretinal surgery was 4% and was significantly increased in patients with coronary artery disease, asthma, chronic renal disease, or receiving general anesthesia. In this series, preoperative testing did not measurably influence rates of postoperative systemic complications.
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Palamaras I, Semkova K. Perioperative management of and recommendations for antithrombotic medications in dermatological surgery. Br J Dermatol 2015; 172:597-605. [DOI: 10.1111/bjd.13362] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2014] [Indexed: 12/30/2022]
Affiliation(s)
- I. Palamaras
- Department of Dermatology; Barnet General Hospital; Royal Free Foundation Trust; Wellhouse Lane Barnet EN5 3DJ London U.K
| | - K. Semkova
- Department of Dermatology and Venereology; Medical University-Sofia; Sofia Bulgaria
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The use of perioperative antithrombotics in posterior segment ocular surgery. Am J Ophthalmol 2014; 158:858-9. [PMID: 25437829 DOI: 10.1016/j.ajo.2014.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/02/2014] [Accepted: 08/04/2014] [Indexed: 11/20/2022]
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Perioperative management of antithrombotic medications in vitreoretinal surgery. Int Ophthalmol Clin 2014; 54:199-213. [PMID: 24613893 DOI: 10.1097/iio.0000000000000024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Management of delayed suprachoriodal haemorrhage after intraocular surgery and trauma. Graefes Arch Clin Exp Ophthalmol 2014; 252:1189-93. [PMID: 24473672 DOI: 10.1007/s00417-013-2550-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 10/31/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND [corrected] To indentify surgical risk factors for delayed suprachoroidal haemorrhage (DSCH) and to report the outcomes of an effective intervention in a consecutive of patients. METHODS The clinical data of ten patients diagnosed with DSCH in our hospital between July 2007 and December 2012 were extracted from hospital records and analyzed, including ophthalmologic examination, ophthalmologic ultrasonography, surgical procedures, and outcome measures including visual acuity and intraocular pressure. RESULTS Ten eyes of ten patients including six men and four women with mean age of 56.6 ± 17.67 years, with DSCH, were enrolled. After diagnosis, drainage or/and pars plana vitrectomy were performed for eight patients; another two received conservative treatment. All the patients were followed up for 15.2 ± 4.3 months. Intraocular pressure decreased significantly (p < 0.001); the mean final visual acuity improved significantly after intervention (p < 0.001). CONCLUSIONS We emphasized other great risk factors such as intraoperative mitomycin-C use, systemic anticoagulation or thrombolysis, and chronic kidney disease. It seems that earlier surgical intervention after the diagnosis of DSCH will be beneficial to patients by improving their final visual acuity.
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Ryan A, Saad T, Kirwan C, Keegan DJ, Acheson RW. Maintenance of perioperative antiplatelet and anticoagulant therapy for vitreoretinal surgery. Clin Exp Ophthalmol 2012; 41:387-95. [PMID: 23094982 DOI: 10.1111/ceo.12017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 08/13/2012] [Indexed: 12/24/2022]
Affiliation(s)
- Andrea Ryan
- Mater Misericordiae University Hospital; Dublin; Ireland
| | - Tahira Saad
- Mater Misericordiae University Hospital; Dublin; Ireland
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MAINTENANCE OF ANTICOAGULANT AND ANTIPLATELET AGENTS FOR PATIENTS UNDERGOING PERIBULBAR ANESTHESIA AND VITREORETINAL SURGERY. Retina 2012; 32:1868-73. [DOI: 10.1097/iae.0b013e31825097ae] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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ANATOMICAL AND VISUAL RESULTS OF TRANSCONJUNCTIVAL SUTURELES VITRECTOMY USING SUBCONJUNCTIVAL ANESTHESIA PERFORMED ON SELECT PATIENTS TAKING ANTICOAGULANT AND ANTIPLATELET AGENTS. Retina 2012; 32:905-11. [DOI: 10.1097/iae.0b013e31822f55c4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fabinyi DCA, O'Neill EC, Connell PP, Clark JB. Vitreous cavity haemorrhage post-vitrectomy for diabetic eye disease: the effect of perioperative anticoagulation and antiplatelet agents. Clin Exp Ophthalmol 2011; 39:878-84. [DOI: 10.1111/j.1442-9071.2011.02575.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Antiplatelet and anticoagulation therapy in vitreoretinal surgery. Am J Ophthalmol 2011; 151:934-939.e3. [PMID: 21411057 DOI: 10.1016/j.ajo.2010.09.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/23/2010] [Accepted: 09/24/2010] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate changes in the prevalence of antiplatelet (aspirin, clopidogrel) and anticoagulation (warfarin) therapy and its possible relationship to postoperative bleeding in vitreoretinal surgery (VRS) patients. DESIGN Observational, retrospective case control study. METHODS setting: University practice.study population: A total of 822 patents who underwent VRS during 3 intervals in 1994, 2004, and 2008.observation procedure: Retrospective chart review for 1994 and 2004, but contemporaneous in 2008.main outcome measures: Proportion using antiplatelets or anticoagulants, the incidence of early postoperative intraocular bleeding in patients, and clinical consequence of the hemorrhage. RESULTS Thirty-one of 213 patients (14.6%) who underwent VRS in 1994, 103 of 361 patients (28.5%) in 2004, and 80 of 248 patients (32.3%) in 2008 had taken antiplatelet therapy (P < .001). The rates of anticoagulant therapy did not vary. The incidence of bleeding was higher (20.0%) in the patients who did not suspend antiplatelets than in those who did (9.6%) (P = .05, χ(2) test), but this difference lost statistical significance in a multivariate analysis (P = .079). Anticoagulant was associated with intraocular hemorrhage at postoperative first day after vitrectomy (P = .03, Fisher exact test). No reoperation or failure of the surgery was attributable to the hemorrhage in anticoagulant or antiplatelet patients. CONCLUSIONS Use of antiplatelet agents has increased in patients undergoing vitreoretinal surgery but probably does not increase the risk of postoperative intraocular bleeding; however, when safe to suspend even for a short time the potential risk is further reduced. Anticoagulant use was associated with a higher risk, but without serious consequences. Working with a patient's medical doctor may allow safe suspension in some cases, which may further lower these risks.
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Mason JO, Gupta SR, Compton CJ, Frederick PA, Neimkin MG, Hill ML, Heersink MJ, Vail RS, White MF, Feist RM, Thomley ML, Albert MA. Comparison of Hemorrhagic Complications of Warfarin and Clopidogrel Bisulfate in 25-Gauge Vitrectomy versus a Control Group. Ophthalmology 2011; 118:543-7. [DOI: 10.1016/j.ophtha.2010.07.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 07/03/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022] Open
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Lip GYH, Durrani OM, Roldan V, Lip PL, Marin F, Reuser TQ. Peri-operative management of ophthalmic patients taking antithrombotic therapy. Int J Clin Pract 2011; 65:361-71. [PMID: 21314873 DOI: 10.1111/j.1742-1241.2010.02538.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Increasing number of patients presenting for ophthalmic surgery are using oral anti-coagulant and anti-platelet therapy. The current practice of discontinuing these drugs preoperatively because of a presumed increased risk of bleeding may not be evidence-based and could pose a significant risk to the patient's health. To provide an evidence-based review on the peri-operative management of ophthalmic patients who are taking anti-thrombotic therapy. In addition, we briefly discuss the underlying conditions that necessitate the use of these drugs as well as management of the operative field in anti-coagulated patients. A semi-systematic review of literature was performed. The databases searched included MEDLINE, EMBASE, database of abstracts of reviews of effects (DARE), Cochrane controlled trial register and Cochrane systematic reviews. In addition, the bibliographies of the included papers were also scanned for evidence. The published data suggests that aspirin did not appear to increase the risk of serious postoperative bleeding in any type of ophthalmic surgery. Topical, sub-tenon, peri-bulbar and retrobulbar anaesthesia appear to be safe in patients on anti-thrombotic (warfarin and aspirin) therapy. Warfarin does not increase the risk of significant bleeding in most types of ophthalmic surgery when the INR was within the therapeutic range. Current evidence supports the continued use of aspirin and with some exceptions, warfarin in the peri-operative period. The risk of thrombosis-related complications on disruption of anticoagulation may be higher than the risk of significant bleeding by continuing its use for most types of ophthalmic surgery.
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Affiliation(s)
- G Y H Lip
- Haemostasis Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
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Silva PS, Cavallerano JD, Sun JK, Aiello LM, Aiello LP. Effect of systemic medications on onset and progression of diabetic retinopathy. Nat Rev Endocrinol 2010; 6:494-508. [PMID: 20664533 DOI: 10.1038/nrendo.2010.122] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diabetic retinopathy remains a leading cause of visual loss worldwide. Patients with diabetes mellitus commonly have multiple comorbidities treated with a wide variety of medications. Systemic medications that target glycemic control and coexisting conditions may have beneficial or deleterious effects on the onset or progression of diabetic retinopathy. In addition, data is accumulating to suggest that the use of systemic therapy primarily to address ocular complications of diabetic retinopathy may be a promising therapeutic approach. This article reviews our current understanding of the ocular-specific effects of systemic medications commonly used by patients with diabetes mellitus, including those directed at control of hyperglycemia, dyslipidemia, hypertension, cardiac disease, anemia, inflammation and cancer. Current clinical evidence is strongest for the use of angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers in preventing the onset or slowing the progression of early diabetic retinopathy. To a more limited extent, evidence of a benefit of fibrates for diabetic macular edema exists. Numerous other agents hold considerable promise or potential risk. Thus, these compounds must undergo further rigorous study to determine the actual clinical efficacy and adverse effects before definitive therapeutic care recommendations can be offered.
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Affiliation(s)
- Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, 1 Joslin Place, Boston, MA 02215, USA
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:605-9. [DOI: 10.1097/aco.0b013e3282f355c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Charles S, Rosenfeld PJ, Gayer S. Medical Consequences of Stopping Anticoagulant Therapy Before Intraocular Surgery or Intravitreal Injections. Retina 2007; 27:813-5. [PMID: 17891002 DOI: 10.1097/iae.0b013e318154b9f2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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