Assessing the Safety of Eyelid Surgery in Patients on Antithrombotic Therapy: Empirical Evidence Supporting Favourable Outcomes

Abstract

Purpose To evaluate the incidence of bleeding complications of oculoplastic procedures performed under antithrombotic therapy and local anaesthesia.

Materials and Methods A prospective study of patients on antithrombotics undergoing pre-septal and post-septal oculoplastic procedures under local anaesthesia over a 12-month period. The type of antithrombotic, surgical details, intra and post-operative complications were documented. Exclusion criteria were high bleeding–risk procedures, such as orbital surgery and dacryocystorhinostomy.

Results 302 patients were included, mean age was 70.7 ± 14.7. years (19 – 98). 77 patients (25.5%) on antithrombotics were advised to continue their medication prior to surgery. The types of antithrombotics taken by patients at the time of surgery were 60.9% antiplatelets, 33.3% anticoagulants and 5.8% combination therapy. Amongst patients who continued taking their oral antithrombotic medications, there was no major intraoperative or perioperative bleeding complications, and no patients required additional surgical or medical reintervention. One self-resolving postoperative bleed occurred after upper-lid blepharoplasty in a patient on aspirin and rivaroxaban. Bleeding rates did not differ between patients who continued antithrombotics and those not receiving antithrombotics (p = 1.00).

Conclusion This study found no incidence of severe bleeding complications in oculoplastic procedures among patients continuing anticoagulant or antiplatelet therapy, consistent with existing literature. Continuation of anticoagulants and antiplatelets appears safe for selected procedures, simplifying patient management and minimizing thromboembolic risk. Emphasis should be placed on meticulous intraoperative haemostasis rather than discontinuation of antithrombotic therapy.

Zusammenfassung

Zielsetzung Ziel dieser Studie war es, die Inzidenz von Blutungskomplikationen bei okuloplastischen Eingriffen unter antithrombotischer Therapie und Lokalanästhesie zu untersuchen.

Materialien und Methoden Es wurde eine prospektive Studie an Patienten durchgeführt, die sich über einen Zeitraum von 12 Monaten präseptalen und postseptalen okuloplastischen Eingriffen in Lokalanästhesie unterzogen. Art der antithrombotischen Medikation, chirurgische Details sowie intra- und postoperative Komplikationen wurden dokumentiert. Als Ausschlusskriterien galten Eingriffe mit hohem Blutungsrisiko, einschließlich orbitaler Operationen und Dakryozystorhinostomie.

Ergebnisse Insgesamt wurden 302 Patienten eingeschlossen; das mittlere Alter betrug 70,7 ± 14,7 Jahre (19 – 98). 77 Patienten (25,5%) unter antithrombotischer Therapie wurden angewiesen, ihre Medikation fortzuführen. Die Antithrombotika verteilten sich auf 60,9% Thrombozytenaggregationshemmer, 33,3% Antikoagulanzien und 5,8% Kombinationstherapie. Bei Patienten mit fortgeführter Therapie traten keine schweren intra- oder perioperativen Blutungskomplikationen auf, und es war keine zusätzliche Intervention erforderlich. Eine selbstlimitierende postoperative Blutung trat nach Oberlid-Blepharoplastik bei einem Patienten unter Acetylsalicylsäure und Rivaroxaban auf. Die Blutungsraten unterschieden sich nicht signifikant zwischen Patienten mit und ohne antithrombotische Therapie (p = 1,00).

Schlussfolgerung Schwere Blutungskomplikationen traten bei okuloplastischen Eingriffen unter fortgeführter Antikoagulations- oder Thrombozytenaggregationshemmung nicht auf. Die Weiterführung dieser Therapie erscheint bei ausgewählten Eingriffen sicher, vereinfacht das Management und reduziert das thromboembolische Risiko. Der Schwerpunkt sollte auf sorgfältiger intraoperativer Hämostase liegen und nicht auf dem Absetzen der antithrombotischen Therapie.

Keywords

oculoplastic surgery - antithrombotic therapy - bleeding complications

Schlüsselwörter

Okuloplastik - antithrombotische Therapie - Blutungskomplikationen

Publication History

Received: 02 November 2025

Accepted: 14 January 2026

Article published online:
11 February 2026

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