Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery

Katz, Joanne; Feldman, M; Bass, Eric B.; Lubomski, Lisa H.; Tielsch, James M.; Petty, Brent G.; Fleisher, Lee A.; Schein, Oliver D.

doi:10.1016/s0161-6420(03)00785-1

Cited by 175 publications

(125 citation statements)

References 20 publications

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Section: Introductionmentioning

confidence: 72%

“…The largest reported series involved 19 283 cataract operations, 6 which in common with other reports, did not identify an increased risk of haemorrhagic complications during local anaesthesia 6,7 or cataract surgery. 6,8,9 Other studies have reported an increased risk of minor haemorrhagic, but not visually threatening complications in patients taking warfarin. [10][11][12][13][14] The Royal College of Ophthalmologists' Cataract Surgery Guidelines (2004) recommends that patients taking aspirin should continue it before cataract surgery, and patients taking warfarin should continue this medication but that the INR should be within the therapeutic level.…”

Section: Introductionmentioning

confidence: 72%

“…We have identified the prevalence of aspirin and warfarin use in the UK cataract population as 28.1 and 5.1%, respectively, higher than the reported prevalence in a large study of cataract operations performed in the United States and Canada. 6 Clopidogrel is used in 1.9% of patients undergoing cataract surgery and dipyridamole in 1.0% and patients using these medications will, therefore, be encountered regularly. We have identified an increase in the overall recording of sharp needle and subtenon's cannula local anaesthetic complications, in particular, an increase in subconjunctival haemorrhage in patients using clopidogrel or warfarin.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Cataract National Dataset electronic multicentre audit of 55 567 operations: antiplatelet and anticoagulant medications

Benzimra

Johnston

Jaycock

et al. 2008

Eye

104

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Aims This study aims to establish the prevalence of aspirin, dipyridamole, clopidogrel, and warfarin use in patients undergoing cataract surgery, and to compare local anaesthetic and intraoperative complication rates between users and non-users. Methods The Cataract National Dataset was remotely extracted and anonymised on 55 567 operations at 12 NHS Trusts using electronic patient records (EPRs) between 2001 and 2006. Results This report analyses 48 862 of the 55 567 operations from the eight centres, which routinely recorded a drug history. In all, 28.1% of the 48 862 patients were taking aspirin, 5.1% warfarin, 1.9% clopidogrel, and 1.0% dipyridamole. The recording of any complication of a sharp needle or subtenon's cannula local anaesthetic block was increased in patients taking clopidogrel, 8.0% (Po0.0001) or warfarin, 6.2% (P ¼ 0.0026) vs non-users, 4.3%, but no increase in potentially sight-threatening complications was identified. The incidence of subconjunctival haemorrhage was increased in patients taking clopidogrel, 4.4% (Po0.0001) or warfarin, 3.7% (Po0.0001) vs non-users, 1.7%. The recording of any operative complication was increased in those taking clopidogrel, 7.3% (P ¼ 0.0002) vs non-users, 4.4%, but the haemorrhagic operative complications of choroidal/ suprachoroidal haemorrhage and hyphaema were not significantly increased. The non-haemorrhagic complication of posterior capsular rupture (PCR) was increased in those taking clopidogrel, 3.23% (P ¼ 0.0057) vs non-users, 1.77%.Conclusions Clopidogrel or warfarin use was associated with a significant increase in minor complications of sharp needle and subtenon's cannula local anaesthesia but was not associated with a significant increase in potentially sight-threatening local anaesthetic or operative haemorrhagic complications.

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Section: Introductionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Cataract National Dataset electronic multicentre audit of 55 567 operations: antiplatelet and anticoagulant medications

Benzimra

Johnston

Jaycock

et al. 2008

Eye

104

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“…5,6 Furthermore, no differences in major haemorrhagic events are noted among patients who had their anticoagulation treatment stopped in the perioperative period for ocular surgery when compared to patients who did not stop therapy. 7,8 This case illustrates the challenges of operating on patients requiring anticoagulation therapy. The introduction of the low molecular weight heparin agents has led to the promise of easier administration.…”

Section: Commentmentioning

confidence: 99%

Total hyphema following postoperative enoxaparin (Clexane)

Sharan

Painter²,

Grigg

2004

Eye

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“…It is therefore likely that more patients are undergoing invasive therapy while receiving antithrombotic therapy. There is already a consensus on the management of antithrombotic agents for tooth extraction (1), cataract surgery (2), and gastrointestinal endoscopy (3), but a consensus has not yet been reached on antithrombotic therapy for many other invasive medical procedures. It is not uncommon for these patients to undergo intra-arterial catheter procedures [coronary angiography (CAG), percutaneous coronary intervention (PCI), cerebral angiography, leg angiography, etc.].…”

Section: Introductionmentioning

confidence: 99%

Safety and Management of Antithrombotic Therapy with Intra-Arterial Catheter Procedures

et al. 2015

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Objective Intravascular catheter procedures are often performed in patients undergoing antithrombotic therapy. However, methods for the management of antithrombotic agents in the perioperative period are currently unclear. Therefore, the safety and management of antithrombotic agents in these patients were investigated. Methods A prospective, multicenter, observational study [Management of Antithrombotic Agents During Surgery or Medical Procedures with Bleeding (MARK study)] at 58 National Hospital Organization institutions in Japan was performed. 1,040 patients were enrolled in the MARK study and underwent an intravascular catheter procedure. For all participants, the details of the procedure, method of perioperative management of antithrombotic agents, and occurrence of thrombosis, embolism, and bleeding complications during the study period were investigated. Results The use of antithrombotic agents was continued in 1,017 patients (98%, continuation group) and discontinued in the other 23 (2%, discontinuation group). Continuation of the antithrombotic agents did not have a significant effect on the overall occurrence of thromboembolism [hazard ratio (HR), 0.15; p=0.08] or bleeding events (HR, 0.19; p=0.12). However, the overall adverse event risk was significantly lower in the continuation group than in the discontinuation group (HR, 0.18; p=0.03). Conclusion It is both safe and appropriate to perform intravascular catheter procedures in patients continuing with antithrombotic therapy.

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Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery

Cited by 175 publications

References 20 publications

The Cataract National Dataset electronic multicentre audit of 55 567 operations: antiplatelet and anticoagulant medications

The Cataract National Dataset electronic multicentre audit of 55 567 operations: antiplatelet and anticoagulant medications

Total hyphema following postoperative enoxaparin (Clexane)

Safety and Management of Antithrombotic Therapy with Intra-Arterial Catheter Procedures

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