Clopidogrel therapy in ophthalmic procedures: a survey of subspecialty ophthalmologists and review of current guidelines

Objective: To assess the knowledge and practice of subspecialty ophthalmologists with respect to perioperative clopidogrel therapy in ophthalmic procedures. Design: Mail survey composed of 5 questions. Participants: Fifteen subspecialty ophthalmologists (3 in each of the fields of surgical retina, anterior segment, oculoplastics, strabismus, and glaucoma) in 3 academic centers in Toronto, Ontario. Methods: Study parcipants completed an anonymous mail survey consisting of multiple-choice and short-answer questions. We studied participants' knowledge about and clinical practices regarding the use of clopidogrel in the perioperative period of specified ophthalmic procedures. We evalutated perceived risks of halting clopidogrel indicated for both primary and secondary prevention of cardiovascular events, as well as clinical decisions regarding clopidogrel in the perioperative period of specified ophthalmic procedures. Results: There was marked variability and relative lack of knowledge by subspecialty ophthalmologists in the management of clopidogrel in the perioperative period. Only 1 respondent identified coronary stent thrombosis or restenosis as a potential and life-threatening risk of halting clopidogrel therapy in these patients. Conclusions: In patients with coronary stents, the risks of halting clopidogrel therapy in the perioperative period are potentially life-threatening and include stent thrombosis and myocardial infarction. Ophthalmic surgeons should pay close attention to the indications for clopidogrel therapy in their patients and should enlist appropriate collaboration with their colleagues in cardiology to minimize risks to their patients.