Discontinuing aspirin or warfarin optional before cataract surgery - Patient oriented evidence that matters: practice recommendations from key studies - Author Abstract

Journal of Family Practice: Discontinuing aspirin or warfarin optional before cataract surgery - Patient oriented evidence that matters: practice recommendations from key studies - Author Abstract

Katz J, Feldman MA, Bass EB, et al. Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. Ophthalmology 2003; 110:1784-1788.

PRACTICE RECOMMENDATIONS

Neither warfarin nor aspirin need to be stopped before cataract surgery: patients who continue to use warfarin or aspirin are not at increased risk of ocular hemorrhagic events. Conversely, those who discontinue warfarin or aspirin prior to cataract surgery have no increased risk of thromboembolic or cardiovascular events.

POEM (Patient-Oriented Evidence that Matters)

Discontinuing aspirin or warfarin is optional for cataract surgery


Question Should anticoagulants and antiplatelet agents be stopped before cataract surgery?


Synopsis In theory, having cataract surgery while taking anticoagulants might increase the risk of ocular haemorrhage. Is there any benefit to continued anticoagulation? Although this isn't the best possible study, it is the best available evidence to date on this question. In this cohort study, the authors looked at all patients undergoing cataract surgery who were older than 50 years and had no history of acute myocardial infarction and whose surgery used general anaesthesia.

Patients who took aspirin were considered to have stopped if their last dose occurred 14 days before surgery, and those who took warfarin were considered non-users if the last dose occurred four days before surgery. Of 19 354 patients undergoing 20 775 operations, 94.1% agreed to participate, and 99.8% of the participants provided an interview seven days after the surgery.

Regarding aspirin, 76.7% did not routinely use aspirin, 5.2% used aspirin and discontinued its use, and 18% continued to use aspirin through surgery.

Regarding warfarin, 96.1% did not use it, 1.1% discontinued use, and 2.8% continued use.

There was no significant difference between groups in the risk of ocular haemorrhage between patients who continued or discontinued aspirin, and no ocular haemorrhage occurred among warfarin users.

The risk of myocardial infarction, haemorrhagic cystitis, myocardial ischaemia, stroke, or deep vein thrombosis did not differ.

If anything, there was a slightly greater risk for those who continued use of warfarin and aspirin, perhaps because the providers felt that their patients were at increased risk.

Bottom line It seems that continued use of warfarin or aspirin puts patients at little risk of ocular haemorrhage during cataract surgery.

Conversely, the risk of thromboembolic or cardiovascular events does not seem to be increased if these agents are discontinued.


Level of evidence 2b (see www.infopoems.com/resources/levels.html). Individual cohort study or low quality randomised controlled trials (< 80% follow up).

Katz J, Feldman MA, Bass EB, et al. Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. Ophthalmology 2003;110: