From the Guidelines
Eliquis (apixaban) should be discontinued before corneal transplant surgery due to its anticoagulant properties that increase bleeding risk during and after the procedure, with the most recent guidelines suggesting cessation 2-3 days prior to surgery for patients with normal bleeding risk 1.
Perioperative Management of Eliquis
The management of Eliquis in patients undergoing corneal transplant surgery involves careful consideration of the bleeding risk and thrombotic risk.
- The anticoagulant effect of Eliquis, which works by inhibiting Factor Xa in the coagulation cascade, prevents blood clot formation but simultaneously increases the risk of surgical bleeding.
- Corneal transplantation requires precise surgical technique, and even minor bleeding can compromise surgical outcomes by obscuring the surgical field, interfering with graft placement, or causing postoperative complications like hyphema (bleeding into the anterior chamber of the eye).
- According to the most recent guidelines, patients should stop taking Eliquis approximately 2-3 days before scheduled corneal transplant surgery, though the exact timing may vary based on individual patient factors such as kidney function and bleeding risk 1.
Resumption of Eliquis Therapy
After surgery, the ophthalmologist and cardiologist should collaborate to determine when it's safe to resume Eliquis therapy, typically 24-48 hours after surgery once hemostasis is confirmed, balancing the risks of bleeding against those of thrombotic events 1.
- The decision to resume Eliquis therapy should be based on the individual patient's risk factors, including kidney function, bleeding risk, and thrombotic risk.
- The most recent guidelines suggest that prophylactic low-molecular-weight heparin (LMWH) may be considered in the interim period before resuming Eliquis therapy, especially in patients with high thrombotic risk 1.
Evidence-Based Recommendations
The recommendations for the perioperative management of Eliquis in patients undergoing corneal transplant surgery are based on the most recent guidelines from reputable sources, including the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines 1 and the Association of Anaesthetists 1.
- These guidelines emphasize the importance of careful consideration of the bleeding risk and thrombotic risk in individual patients, as well as the need for collaboration between ophthalmologists, cardiologists, and other healthcare professionals to ensure optimal patient outcomes.
From the Research
Eliquis Contraindication in Corneal Transplant Patients
- There is no direct evidence in the provided studies that explains why Eliquis (apixaban) is contraindicated in patients undergoing corneal transplant surgery.
- The studies focus on the use of immunosuppressive agents to prevent graft rejection in high-risk corneal transplantation 2, the reduction of corneal neovascularization to improve graft survival 3, 4, and the safety of cataract surgery in patients taking new oral anticoagulants (NOACs) 5.
- One study mentions the safety of phacoemulsification in patients taking NOACs, including apixaban, but does not address corneal transplant surgery specifically 5.
- Another study discusses endothelial graft failure after contralateral autologous corneal transplantation, but does not mention Eliquis or apixaban 6.
- Therefore, there are no research papers in the provided evidence to assist in answering this question.