Variability in perioperative anticoagulation management for MIGS highlights need for guidelines

A recent survey of American Glaucoma Society (AGS) surgeons found significant variability in perioperative anticoagulation and antiplatelet management for minimally invasive glaucoma surgery (MIGS).

Among 103 respondents, most performed MIGS procedures targeting the trabecular meshwork, either through tissue excision (40%) or device implantation (24.9%). Although half of the surgeons frequently consulted primary care physicians regarding anticoagulation, 59.3% reported managing blood thinners differently for MIGS compared to more invasive surgeries like trabeculectomy or tube implantation.

Bleeding risk perception varied widely, with lower concern for trabecular meshwork bypass with device implantation (74% reporting no or mild concern) and higher concern for tissue excision procedures (48% reporting high concern). Surgeons most often stopped anticoagulants for procedures enhancing aqueous outflow through the subconjunctival space, while discontinuation was least common for iStent implantation. Antiplatelets were paused for longer durations preoperatively, though both anticoagulants and antiplatelets were typically resumed within 1–4 days post-surgery.

Reference
Pradeep T, Schwartz T, Sankar PS, et al. Anticoagulation for Minimally Invasive Glaucoma Surgery: An American Glaucoma Society Survey. J Glaucoma. 2025;34(2):77-83. doi: 10.1097/IJG.0000000000002518. Epub 2024 Nov 18. PMID: 39792810.