Control of Perioperative Bleeding in Vitreoretinal Surgery

Purpose.To investigate the effect of menstrual cycle on perioperative bleeding of primary vitreoretinal surgery.Methods.Data on female patients who had vitrectomy surgery was retrospectively collected. Exclusion criteria were history of trauma, vitreous hemorrhage, previous vitreoretinal surgery, diabetic retinopathy, endophthalmitis, acute retinal necrosis, single vitreous opacity, and use of antiplatelet agents. Perioperative bleeding was defined as hemorrhage in the iris, vitreous, choroidal, retina, or subretina during surgery or up to one day postoperatively. 69 patients had surgery during the perimenstrual phase (group M, days 1–7 and days 21–28) and 86 during periovulatory phase (group O, days 8–20) were enrolled.Results.The proportion of operative bleeding in group M (14.5%) and group O (10.5%) was not found to be significantly different (p=0.45). No postoperative bleeding was recorded in both groups. The univariate odds ratio (OR) and 95% confidence interval (CI) of perimenstrual phase for operative bleeding were 0.69 (0.26–1.81). After adjusting for patients’ age, vitreoretinal diseases, and surgeons, the multivariate OR and 95% CI were 0.71 (0.27–1.86).Conclusion.This study suggests that the timing of the menstrual period does not affect perioperative bleeding for primary vitreoretinal surgery. Menstruation appears not to be a contraindication for vitreoretinal surgery.

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Determination and Treatment of Disorders of Primary Haemostasis

Hämostaseologie ◽

10.1055/s-0038-1660415 ◽

1999 ◽

Vol 19 (04) ◽

pp. 168-175 ◽

Cited By ~ 6

Author(s):

M. Weippert-Kretschmer ◽

V. Kretschmer

Keyword(s):

Platelet Function ◽

Bleeding Risk ◽

Bleeding Complications ◽

Bleeding Tendency ◽

Platelet Counts ◽

Platelet Function Disorders ◽

Perioperative Bleeding ◽

Before And After ◽

Low Sensitivity

SummaryPerioperative bleeding complications due to disorders of primary haemostasis are often underestimated. Routine determination of primary haemostasis is still problematic. The in vivo bleeding time (BT) shows low sensitivity and high variability. In this contribution the results and experiences with the IVBT having been obtained in various studies and during 10 years of routine use are reported. Patients and Methods: Blood donors before and after ASA ingestion, patients with thrombocytopenia as well as congenital and acquired platelet function disorders. Monitoring of desmopressin efficacy. IVBT with Thrombostat 4000 (tests with CaCl2 = TST-CaCl2 and ADP = TST-ADP) and PFA-100 (test cartridges with epinephrine = PFA-EPI and ADP = PFA-ADP). Results and Conclusions: IVBT becomes abnormal with platelet counts <100,000/μl. With platelet counts <50,000/μl the results are mostly outside the methodical range. IVBT proved clearly superior to BT in von Willebrand syndrome (vWS). All 16 patients with vWS were detected by PFA-EPI, whereas with BT 7 of 10 patients with moderate and 1 of 6 patients with mild forms of vWS were spotted. The majority of acquired and congenital platelet function disorders with relevant bleeding tendency were detectable by IVBT. Sometimes diagnostic problems arose in case of storage pool defect. Four to 12 h after ingestion of a single dose of 100 mg ASA the TST-CaCl2 became abnormal in all cases, the PFA-EPI only in 80%. However, the ASA sensitivity of TST-CaCl2 proved even too high when looking for perioperative bleeding complications in an urological study. Therefore, the lower ASS sensitivity of the PFA-100 seems to be rather advantageous for the estimation of a real bleeding risk. The good efficacy of desmopressin in the majority of cases with mild thrombocytopenia, congenital and acquired platelet function disorders and even ASS-induced platelet dysfunction could be proven by means of the IVBT. Thus IVBT may help to increase the reliability of the therapy. However, the IVBT with the PFA-100 is not yet fully developed. Nevertheless, routine use can be recommended when special methodical guidelines are followed.

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