Is It Really Safe to Discontinue Anticoagulant/antiplatelet Treatment Before Ptosis Surgery From Serious Bleeding?

Purpose: To evaluate the effects of discontinuing anticoagulants(ACs)/antiplatelets(APs) preoperatively on surgery for blepharoptosis Method: A retrospective analysis included patients with acquired blepharoptosis who underwent surgical correction, and were followed for more than one month. Patients were classified into two groups depending on AC/AP treatment or otherwise. All patients taking AC/AP discontinued with the treatment one week prior to surgery in accordance with our clinical guidelines. Preoperative and postoperative marginal reflex distance 1(MRD1) and ecchymosis grade were evaluated and compared. Results: Group 1 (AC/AP treatment cessation) included 47 patients with 93 eyelids, and group 2 (control) included 51 patients with 98 eyelids. The preoperative MRD1 showed no significant difference between groups. Group 1 showed a significantly higher rate of severe ecchymosis (41.8 vs. 22.4%, p = 0.004) at 1 week of surgery as well as 'persistent ecchymosis (58.8 vs. 7.3%, p=0.000) compared with group 2 postoperatively at 1 month. Postoperative MRD1 was significantly lower in group 1 at 1 week (p=0.019). However, the MRD1 and degree of improvement in lid height (postoperative MRD1–preoperative MRD1) was not significantly different between the two groups (p = 0.499, p = 0.058) at 1 month postoperatively. Conclusion: Postoperative ecchymosis was more severe in group 1 at one month after ptosis surgery even though the ACs/APs were discontinued. Surgeons should be careful about this before operation.