Multiple studies over the past 2 decades repeatedly demonstrate that the risks associated with discontinuation of coumadin and antiplatelet therapy in patient at high risk for thrombotic or embolic events exceed  the risks associated with excessive bleeding during surgery.  The attached recent study is one more study that affirms this.  Patients needing more involved surgery, such as cases anticipating sutured IOLs, vitrectomy, membrane pealing, etc; however, may need to hold antiplatelet therapy in advance of this nonroutine surgery.

Risk assessment of simple phacoemulsification in patients on combined anticoagulant and antiplatelet therapy

Purpose

To assess the safety of phacoemulsification cataract extraction in patients on combined anticoagulant and antiplatelet treatment.

Setting

Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.

Design

Prospective interventional case series.

Methods

Consecutive patients with simple cataract on combined anticoagulant (warfarin) and antiplatelet (aspirin or clopidogrel) treatment who were unable to discontinue the treatment because of a high risk for thromboembolic events were included. Patients had cataract extraction under topical anesthesia with a clear corneal incision (CCI), phacoemulsification, and implantation of a foldable posterior chamber intraocular lens. Prothrombin time–international normalized ratio and platelet functions were evaluated immediately before surgery. Patients were also examined 1 day and 7 days postoperatively. Intraoperative and postoperative ocular bleeding and other related complications were assessed.

Results

Forty patients (51 eyes) with a mean age of 72 years (range 51 to 90 years) had phacoemulsification. Hemorrhagic complications were not observed at surgery or during the 1-week follow-up. Surgical complications included 1 rupture of the capsulorhexis and 1 implantation of a capsular tension ring due to partial zonulysis. No patient had a thromboembolic event.

Conclusions

In patients with uncomplicated cataract at high risk for thromboembolic events, phacoemulsification cataract surgery using a CCI under topical needle-free anesthesia was safely performed without discontinuing systemic anticoagulant and antiplatelet treatment