Risk Management



Anticoagulant Consent

OMIC is grateful to the ophthalmologists on our Board for their expertise. This specific document reflects the input of the following Board members:  Tamara R. Fountain, M.D., and Ronald W. Pelton, M.D..

INFORMED CONSENT FOR STOPPING OR CONTINUING BLOOD-THINNERS (ANTICOAGULANTS)

WHAT ARE BLOOD-THINNERS?

Blood-thinning medications (“anticoagulants”) are powerful tools to prevent complications of life-threatening blood clots and have proven benefits in preventing heart attacks and strokes. They are prescribed to prevent these blood clots from forming in people who are at risk. The benefits of these drugs must always be weighed against bleeding risks, particularly in patients undergoing elective surgical procedures. One of the side-effects of anticoagulants is an increase in bleeding. Patients who take blood thinners like aspirin, Coumadin, Plavix, Pradaxa, etc,. present challenges when surgery is needed.

HOW WILL BLOOD-THINNERS AFFECT MY VISION AND CONDITION?

Bleeding is a potential complication of any surgical procedure. People who take blood-thinning medicine around the time of their procedure are more likely to have bleeding complications during and after surgery. For operations in and around the eye, this bleeding may, in rare cases, cause loss of vision or blindness.

If you stop taking your blood-thinner(s) before surgery to lessen the chance of bleeding, you may be at greater risk of developing a life-threatening blood clot, which can cause very serious conditions such as heart attack, stroke, pulmonary embolism, and deep vein thrombosis. If, on the other hand, you continue your anticoagulants you may be at increased risk of bleeding complications. If you are on blood-thinners and need to have surgery, you must be willing to accept the potential for increased risk of one of these complications—blood clot or bleeding.

Your surgeon and your primary doctor/cardiologist will weigh the relative risks and benefits of stopping or continuing your medications before surgery and counsel you accordingly. On rare occasion, this may mean that elective surgery will be postponed or cancelled.

There is always a chance that you may develop a complication related to how your blood thinners are managed around the time of your surgery.  Your doctors will help you understand the relative risks involved so you can make an informed decision about how to proceed.

PATIENT’S ACCEPTANCE OF RISKS

As a patient on blood-thinners (such as aspirin, Plavix, Coumadin, Pradaxa, etc), I understand that stopping these medicines before surgery may increase my risk of a having a heart attack, stroke or other life-threatening blood clot.  I also understand that if I continue my blood-thinners, I have an increased risk of bleeding complications that may result, in rare cases, in vision loss or blindness.

                                                                                                                       

Patient (or person authorized to sign for patient)         Date

SAMPLE INSTRUCTIONS

NOTE: INCLUDE THE FOLLOWING INFORMATION IF YOUR PATIENT WILL BE STOPPING AND RESTARTING ANTICOAGULANTS. REMOVE IF THE PATIENT WILL BE CONTINUING. MODIFY AS NEEDED TO FIT YOUR PRACTICE.

GIVE THE PATIENT A COPY, PLACE A COPY IN THE MEDICAL RECORD, AND SEND A COPY TO THE SURGERY CENTER OR HOSPITAL SO THAT THEY MAY VERIFY THAT THE PATIENT HAS STOPPED MEDICATION AS INSTRUCTED PRIOR TO SURGERY

INSTRUCTIONS ON HOW TO TAKE YOUR BLOOD-THINNERS BEFORE AND AFTER SURGERY

Blood thinners are very important medications that may save your life.  However, they can complicate surgery by making both the procedure and the after-care more difficult. It is very important to discuss your blood thinner medication with your eye surgeon and your prescribing doctor. Please follow the directions below concerning the stopping and re-starting of your blood thinners. Do not hesitate to call our office or the office of your primary care doctor if you have questions about these instructions

  •  Your blood-thinner medication(s) is:

Aspirin _____                                        Plavix (clopidogrel) _____

Aggrenox _____                                    Pradaxa (dabigatran _____

Coumadin (warfarin) _____                    Xarelto (rivaroxaban) _____

Eliquis (apixaban) _____                        Other: ____________________

  •  Your surgery date is _____________
  •  STOP your blood-thinner medication on [date], which is _________ days before surgery or ______________________________________________
  •  RESTART your blood-thinner medication  on [date], which is __________ days after your surgery or ______________________________________

If you note ANY abnormal symptoms after stopping your blood thinner, please call your prescribing doctor or go to the nearest emergency department as soon as possible.

As always, if you have questions or concerns, please call us anytime at the number below.

[Add contact information for the eye surgeon]

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