斜視手術における抗凝固薬および抗血小板薬の影響

The influence of anticoagulants and/or antiplatelets on the strabismus surgery

要約　目的：抗凝固薬や抗血小板薬を内服中，あるいは直前まで服用していた患者の斜視手術における抗凝固剤などの影響について報告する。

方法：名古屋大学病院で局所麻酔下での斜視手術（直筋の前転，後転術）を施行した10人（抗凝固薬使用2人，抗血小板薬使用8人）について，手術時間，休薬状況，手術1週間前のプロトロンビン国際標準化比，出血性合併症の有無について調べた。

結果：抗凝固薬は1人が継続，1人がヘパリンナトリウム置換（休薬4日），抗血小板薬は5人が中止（14.7±13.3日），2人が継続，1人がダルテパリンナトリウム置換（8日）であった。イコサペント酸エチルの使用例で重度の結膜下出血が1人あった他，出血性合併症はなかった。

結論：内服の継続および中止例のいずれも重篤な合併症を起こさなかった。

Abstract　Purpose: To reveal the influence of anticoagulants/antiplatelets on the strabismus surgery.

Subjects and Methods: Ten patients in Nagoya University Hospital, seven male and three female, were taking anticoagulants/antiplatelets and had undergone rectus muscle recession/resection procedures under local anesthesia during the period of August 2011-March 2015. The mean age of participants were 65.1±10.4 years old. Operation time, anti-thrombotic medication, international normalized ratio-prothrombin time（PT-INR）, perioperative hemorrhagic complication were extracted from clinical records.

Results: Before operation, five patients withdrawn antiplatelets, one patient who was at higher risk of infarction used heparin sodium as a replacement for anticoagulants, another patient used dalteparin sodium to replace antiplatelet, two patients taking antiplatelets and one patient taking anticoagulant did not withdraw. During the perioperative period, no remarkable ocular and general complications were found even if the medications were withdrawn, except for one patient who was using ethyl icosapentate for hypertension, who visited the emergency room after surgery because of severe subconjunctival hemorrhage. Mild hemorrhage was observed in all patients. Mean PT-INR one week before operation was 1.6±0.2（n＝2）for who anticoagulants group and 0.98±0.07（n＝8）for antiplatelets group.

Conclusions: Any severe complications were not observed.