Anticoagulation and Antiplatelet Therapy in Endoscopic Ear Surgery

Introduction: Endoscopic ear surgery (EES) has gained popularity for a variety of reasons, including certain visibility advantages. The proximity of the endoscope lens to the surgical site and single-handed instrumentation results in unique considerations with respect to bleeding and visibility. Prior surgical research assessing anticoagulation (AC) or antiplatelet (AP) therapy in otology has focused on microscopic technique, demonstrating minimal risk. We sought to assess the impact of AC or AP on EES visibility and procedural progression.

Methods: Case-control retrospective chart review of patients on AC/AP undergoing EES from 4/2018-4/2023 at a tertiary care center was performed. Two randomly matched controls not on AC/AP were selected for each case based on procedure type and pathology. Surgical videos were blindly rated by two surgeons utilizing the Modena Bleeding Scale (MBS), evaluating visibility and procedural progression during three-minute clips of three key portions of each case, with 1 representing no bleeding and 5 representing bleeding which prevents progression. Scores and clinical outcomes were compared.

Results: Seventeen cases were identified, 3 of which were excluded because of inability to find a suitable pathologic match or unavailable data, and 28 controls matched. Cases were more often male (85.7%, p< 0.01) and older (median 54.9 years) than controls (median 37.8, p< 0.01). Eleven cases (78.6%) were on aspirin 81mg daily, 2 (14.2%) on coumadin (4mg or 6mg daily) and one (7.1%) on aspirin 325mg daily. No statistically significant difference in MBS was found when comparing cases to matched controls for any of the pathologies or surgical steps. Cases did not have significantly higher intra-operative blood loss, incur additional complications, or differ in clinical outcomes.

Conclusions: There is no significant difference in intra-operative visibility, procedural progress, complications, or outcomes when patients remain on AC/AP medications during EES. EES can safely be performed on patients on AC/AP medications.