Anticoagulation Therapy or Bleeding Disorders
In patients receiving anticoagulation therapy, clear corneal cataract surgery performed with topical anesthesia is not associated with an increased risk of vision-threatening hemorrhagic complications. Minor bleeding problems, such as eyelid ecchymosis, hyphema, and subconjunctival hemorrhage, are more common with anticoagulant use, but these are transient and self-limited. If a retrobulbar block is used, the risk of retrobulbar hemorrhage is higher in patients on anticoagulants. It is important to weigh the systemic risks of discontinuing anticoagulation or antiplatelet therapy with the surgical risks of continuing therapy. When warfarin is continued, the international normalized ratio (INR) is typically maintained within the therapeutic range.
If anticoagulation therapy is to be discontinued or adjusted for surgery, coordination with the prescribing physician is recommended. Discontinuation of anticoagulants is recommended in patients who have previously experienced a suprachoroidal hemorrhage because these patients are predisposed to recurrent bleeding. Time to restoration of normal coagulation is variable and depends on the specific anticoagulant in use; warfarin usually requires 3–5 days. Platelet function resumes 10–21 days after stopping antiplatelet therapy. Typically, it is recommended that patients restart anticoagulant or antiplatelet therapy within the first postoperative day. It is important to ask the patient about the use of all medications, including nonprescription items that may contain aspirin, vitamin E, or vitamin K, which could affect coagulation status. Table 12-1 presents a list of anticoagulant and antiplatelet agents approved by the US Food and Drug Administration (FDA).
In the absence of hypotony or hemorrhagic complications, anticoagulation therapy may be safely resumed following the first postoperative visit. The patient’s coagulation profile should be reviewed preoperatively for systemic conditions that might alter clotting ability. For further discussion of ocular hemorrhage, see Chapter 10.
Grzybowski A, Ascaso FJ, Kupidura-Majewski K, Packer M. Continuation of anticoagulant and antiplatelet therapy during phacoemulsification cataract surgery. Curr Opin Ophthalmol. 2015;26(1):28–33.
Table 12-1 Anticoagulant and Antiplatelet Medications Approved by the US FDAa
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.