Evaluation of the need to discontinue antiplatelet and anticoagulant medications before cataract surgery

Abstract

To assess the risk for intraoperative and postoperative bleeding associated with antiplatelet and/or anticoagulant treatment in patients having uneventful phacoemulsification. Kokura Memorial Hospital, Kitakyusyu, Japan. In a nonrandomized case series, consecutive patients had phacoemulsification and intraocular lens implantation under sub-Tenon anesthesia. All patients were on warfarin, acetylsalicylic acid (aspirin) therapy, or both. Patients discontinued therapy 1 week before surgery (discontinuation group) or continued the therapeutic regimen until the time of surgery (maintenance group). The discontinuation group comprised 182 patients and the maintenance group, 173 patients. There was no significant difference between the 2 groups in the mean prothrombin time-international normalized ratio in patients taking warfarin (P = .6). Although there was no significant intraoperative bleeding in any case, 47 eyes (16.5%) in the maintenance group and 31 eyes (10.8%) in the discontinuation group had a subconjunctival hemorrhage postoperatively (P = .0309). Minor postoperative ocular bleeding occurred in 11 eyes (4.0%) in the maintenance group and 7 eyes (2.5%) in the discontinuation group (P = .4). During the 1-month postoperative period, the mean change in corrected distance visual acuity was -0.462 logMAR +/- 0.331 (SD) in the maintenance group and -0.434 +/- 0.318 logMAR in the discontinuation group (P = .3). Patients taking warfarin, aspirin, or both up to the time of phacoemulsification had a significantly higher incidence of subconjunctival hemorrhage than those who discontinued therapy. There was no significant difference between the 2 groups in the incidence of intraoperative and postoperative complications or in visual improvement. The author has no financial or proprietary interest in any material or method mentioned. Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.