Cold plasma endonasal endoscopic dacryocystorhinostomy in patients taking anticoagulants: a balance between the risk of bleeding and thrombosis
Year: 2026
Type: article
Abstract: Relevance. This study is dedicated to assessing the safety and efficacy of cold plasma (coblation) endonasal endoscopic dacryocystorhinostomy (CP-EDCR) in patients receiving long-term anticoagulant or antiplatelet therapy. Purpose. To evaluate the clinical efficacy, as well as the frequency of hemorrhagic and thromboembolic complications during cold plasma endoscopic dacryocystorinostomy in patients receiving anticoagulant and/or antiplatelet therapy. Material and methods. A study included 43 patients (mean age 66.4±6.1 years) with chronic dacryocystitis who were continuously taking warfarin, direct oral anticoagulants (rivaroxaban, apixaban), or antiplatelet agents. The perioperative management strategy for antithrombotic therapy was determined individually by a multidisciplinary team (ophthalmologist/cardiologist) based on the level of thromboembolic risk. Results. The use of CP-EDCR resulted in intraoperative bleeding requiring additional hemostasis in 7.0% of cases (3 patients), and delayed postoperative epistaxis in 4.65% (2 patients). All hemorrhagic complications occurred in the subgroup with a high thromboembolic risk, where bridging therapy was applied. Thromboembolic complications during the 30-day follow-up period were absent (0%). Anatomical patency of the ostium was maintained after 3 months in 90.7% of patients. Conclusion. Cold plasma EDCR combined with personalized perioperative anticoagulant management is a highly effective and safe method for treating chronic dacryocystitis in patients taking antithrombotic drugs. The technique provides reliable hemostasis and minimizes both hemorrhagic and thromboembolic risks, making it the preferred choice for this patient category. Keywords: chronic dacryocystitis, cold-plasma coblation, endoscopic endonasal dacryocystorhinostomy, anticoagulant therapy, bleeding risk
Authors: M.I. Shlyakhtov, K.G. Naumov, P.M. Rylov
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7204999736