Anticoagulation for Minimally Invasive Glaucoma Surgery: An American Glaucoma Society Survey

Précis: Perspectives and practice patterns regarding perioperative anticoagulation management and minimally invasive glaucoma surgery were queried among surgeons of American Glaucoma Society. Management varied based on surgeon preference and the type of procedure performed. Purpose: The purpose of this study was to characterize anticoagulation and antiplatelet practice patterns for minimally invasive glaucoma surgery (MIGS) in the perioperative period. Materials and Methods: This was a survey of surgeons of American Glaucoma Society (AGS) about anticoagulation decision-making for their most performed MIGS procedures. Results: A total of 103 surgeons completed the survey, with 43.6% in an academic setting, 49.5% in a private practice setting, and 6.8% in a mixed practice. Median MIGS per month was 10 [interquartile range (IQR) 20–5]. The 2 most performed MIGS were trabecular meshwork (TM) bypass with either device implantation (24.9%) or tissue excision (40.0%). Half of the respondents (50.5%) deferred to the primary care physician about anticoagulation most/all the time. Most (59.3%) managed anticoagulation differently for MIGS compared with trabeculectomy and tube implantation. Respondents reported an average of 1.3 (SD 2.5) bleeding complications related to anticoagulation and MIGS in the last year. Bleeding risk perception depended upon the type of surgery (e.g., 74.0% reported no/mild concern regarding surgeries involving TM bypass with device implantation vs. 48.0% reported high concern for TM bypass with tissue excision). Respondents stopped blood thinners at the highest rates for procedures enhancing aqueous outflow through the subconjunctival space and stopped least frequently for iStent implantation. Antiplatelets were held for a longer duration than anticoagulants before surgery, and most resumed both agents within 1–4 days after surgery. Conclusions: Anticoagulation management is highly varied, and this study may help to inform practice guidelines and optimize surgical outcomes by elucidating surgeon perspectives toward MIGS and anticoagulation management.