Postoperative Bleeding Following Involutional Entropion Surgery in an Elderly Patient with a History of Dual Antiplatelet Therapy Use: A Case Report

Andyn Robioleny Saparin; Sukoto Sukoto

doi:10.59141/-.v8i2.467

Authors

Andyn Robioleny Saparin Universitas Jember, Indonesia
Sukoto Sukoto RSUD dr. Soedono Madiun, Indonesia

DOI:

https://doi.org/10.59141/-.v8i2.467

Keywords:

involutional entropion, eyelid surgery, postoperative bleeding, dapt, elderly

Abstract

Elderly patients often undergo dual antiplatelet therapy (DAPT) for cardiovascular conditions, which increases the risk of postoperative bleeding, including after involutional entropion surgery. The management of antiplatelet therapy in the perioperative period remains a clinical challenge that requires careful consideration. This case report aims to discuss the risk of severe postoperative bleeding associated with continuing DAPT during the perioperative period and to emphasize the importance of comprehensive perioperative care in elderly patients undergoing eyelid surgery. A 76-year-old man on DAPT (aspirin and clopidogrel) underwent right involutional entropion surgery. Four days postoperatively, he experienced persistent ocular bleeding requiring hospitalization. Hemoglobin decreased from 12.7 g/dL to 7.5 g/dL, while coagulation parameters remained within normal limits. The patient received a pressure dressing, systemic tranexamic acid, vitamin K, and three units of packed red blood cells. Following cardiology consultation, DAPT was discontinued. The bleeding gradually decreased and completely resolved within six days after DAPT discontinuation. The patient required seven days of hospitalization and blood transfusion due to the significant drop in hemoglobin. No further complications were observed during follow-up. Continuing DAPT during the perioperative period may cause serious postoperative bleeding, even after minor ophthalmic procedures. Careful medication review, multidisciplinary coordination, and patient education are essential to reduce bleeding risk in elderly patients undergoing entropion surgery.

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References

Adams Jr, H. P., & Biller, J. (2015). Classification of subtypes of ischemic stroke: history of the trial of org 10 172 in acute stroke treatment classification. Stroke, 46(5), e114–e117.

Arora, S., Shemisa, K., Vaduganathan, M., Qamar, A., Gupta, A., Garg, S. K., Kumbhani, D. J., Mayo, H., Khalili, H., & Pandey, A. (2019). Premature ticagrelor discontinuation in secondary prevention of atherosclerotic CVD: JACC review topic of the week. Journal of the American College of Cardiology, 73(19), 2454–2464.

Baber, U., Dangas, G., Cohen, D. J., Gibson, C. M., Mehta, S. R., Angiolillo, D. J., Pocock, S. J., Krucoff, M. W., Kastrati, A., & Ohman, E. M. (2016). Ticagrelor with aspirin or alone in high-risk patients after coronary intervention: rationale and design of the TWILIGHT study. American Heart Journal, 182, 125–134.

Banerjee, S., Angiolillo, D. J., Boden, W. E., Murphy, J. G., Khalili, H., Hasan, A. A., Harrington, R. A., & Rao, S. V. (2017). Use of antiplatelet therapy/DAPT for post-PCI patients undergoing noncardiac surgery. Journal of the American College of Cardiology, 69(14), 1861–1870.

Bangalore, S., Maron, D. J., Stone, G. W., & Hochman, J. S. (2020). Routine revascularization versus initial medical therapy for stable ischemic heart disease: a systematic review and meta-analysis of randomized trials. Circulation, 142(9), 841–857.

Cheraqpour, K. (2025). Beauty’s blind spot: unmasking the ocular side effects and concerns of eye cosmetics. Cosmetics, 12(4), 149.

Columbo, J. A., Lambour, A. J., Sundling, R. A., Chauhan, N. B., Bessen, S. Y., Linshaw, D. L., Kang, R., Riblet, N. B. V, Goodney, P. P., & Stone, D. H. (2018). A meta-analysis of the impact of aspirin, clopidogrel, and dual antiplatelet therapy on bleeding complications in noncardiac surgery. Annals of Surgery, 267(1), 1–10.

Ford, I. (2015). Coming safely to a stop: a review of platelet activity after cessation of antiplatelet drugs. Therapeutic Advances in Drug Safety, 6(4), 141–150.

Gillmor, C. L., Khan, J. A., & Sokol, J. A. (2020). Upper eyelid malpositions: retraction, ectropion, and entropion. In Albert and Jakobiec’s principles and practice of ophthalmology (pp. 1–24). Springer.

Gimbel, M. E., Vos, G. J. A., Nguyen, T. A., Kelder, J. C., & Ten Berg, J. M. (2020). Reasons for early discontinuing or switching of antiplatelet therapy in elderly patients after acute coronary syndrome. Coronary Artery Disease, 31(1), 66–72.

Levine, G. N., Bates, E. R., Bittl, J. A., Brindis, R. G., Fihn, S. D., Fleisher, L. A., Granger, C. B., Lange, R. A., Mack, M. J., & Mauri, L. (2016). 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 68(10), 1082–1115.

Mansour, A., Kerman, T., Amitai, N., Zunz, E., Khalaila, S., Hazan, I., & Tsumi, E. (2025). The relationship between involutional ectropion and inflammatory disorders of the eyelids and ocular surface: Insights from a large-scale national study. Scientific Reports, 15(1), 4059.

Matejic-Spasic, M., Hassan, K., Thielmann, M., Geidel, S., Storey, R. F., Schmoeckel, M., Adamson, H., Deliargyris, E. N., & Wendt, D. (2022). Management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiac surgery—A systematic review. Journal of Thoracic Disease, 14(8), 3030.

Mosconi, M. G., & Paciaroni, M. (2022). Treatments in ischemic stroke: current and future. European Neurology, 85(5), 349–366.

Noronha, V. J. (2015). A Clinical Study and Surgical Management of Eyelid Deformities in a Rural Hospital. Rajiv Gandhi University of Health Sciences (India).

O’Donoghue, M. L., Murphy, S. A., & Sabatine, M. S. (2020). The safety and efficacy of aspirin discontinuation on a background of a P2Y12 inhibitor in patients after percutaneous coronary intervention: a systematic review and meta-analysis. Circulation, 142(6), 538–545.

Premji, A. M., Blegen, M. B., Corley, A. M., Ulloa, J., Booth, M. S., Begashaw, M., Larkin, J., Shekelle, P., Girgis, M. D., & Maggard-Gibbons, M. (2023). Dual antiplatelet management in the perioperative period: updated and expanded systematic review. Systematic Reviews, 12(1), 197.

Romeo, M. A., Taloni, A., Borselli, M., Di Maria, A., Mancini, A., Mollace, V., Carnovale-Scalzo, G., Scorcia, V., & Giannaccare, G. (2025). Iatrogenic ocular surface complications after surgery for ocular and adnexal tumors. Cancers, 17(9), 1384.

Rosendorff, C., Lackland, D. T., Allison, M., Aronow, W. S., Black, H. R., Blumenthal, R. S., Cannon, C. P., De Lemos, J. A., Elliott, W. J., & Findeiss, L. (2015). Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation, 131(19), e435–e470.

Wiebe, J., Ndrepepa, G., Kufner, S., Lahmann, A. L., Xhepa, E., Kuna, C., Voll, F., Gosetti, R., Laugwitz, K., & Joner, M. (2021). Early aspirin discontinuation after coronary stenting: a systematic review and meta‐analysis. Journal of the American Heart Association, 10(2), e018304.

Zhao, Y. (2025). The Dilemma and Reconstruction of Students’ Subjectivity from the Perspective of Educational Sociology. Educational Innovation Research, 3(4), 7–13.