Evaluation of the need to discontinue antiplatelet and anticoagulant medications before cataract surgery.
OBJECTIVE
To assess the risk for intraoperative and postoperative bleeding associated with antiplatelet and/or anticoagulant treatment in patients having uneventful phacoemulsification.


METHODS
Kokura Memorial Hospital, Kitakyusyu, Japan.


METHODS
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).


RESULTS
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).


CONCLUSIONS
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.


BACKGROUND
The author has no financial or proprietary interest in any material or method mentioned.
Kobayashi
Hiroshi
H
Department of Ophthalmology, Kanmon Medical Center, Shimonoseki, Japan. kobi@earth.ocn.ne.jp
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage; D016063:Blood Loss, Surgical; D005130:Eye Hemorrhage / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage; D014792:Visual Acuity / Q000502:physiology; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin