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Phacoemulsification cataract surgery in patients receiving novel oral anticoagulant medications

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Abstract

Introduction

An increasing number of patients are taking novel oral anticoagulant (NOAC) medication, making perioperative management in phacoemulsification surgery an important issue. This study reports the haemorrhagic complications of NOAC in phacoemulsification surgery.

Design

Retrospective case study over a 4-year period.

Methods

Consecutive cases receiving NOAC during the time of phacoemulsification were reviewed. Patients were either advised to continue medications (continued group) or withhold medications before surgery (withheld group).

Main outcome measures

Details including patient demographics, preoperative assessment, postoperative outcome and intraoperative, postoperative and systemic complications were recorded.

Results

A total of 20,100 cases of phacoemulsification were performed. Of which, 66 cases were found to be on NOAC (0.33%). This included 66 eyes of 53 patients, with 42 continued and 24 withheld medications before surgery. There was no statistically significant difference between the two groups in demographics, cataract risk factors, baseline renal function, clotting profile, type of NOAC, incision size, phacoemulsification energy, preoperative and postoperative visual acuity. There was also no significant difference in intraoperative, postoperative and systemic complications (p = 1.00 and 0.53, Fischer’s exact test). None of the patients in the continued group had postoperative complications; two cases in the withheld group receiving retrobulbar anaesthesia had bruising and subconjunctival haemorrhage after resumption of NOAC (p = 0.13, Fischer’s exact test).

Conclusion

The present study found no difference in haemorrhagic complications between cases continuing and withholding NOAC during phacoemulsification. Nevertheless, the potential risks and benefits to continue or withhold NOAC perioperatively should be carefully considered via a multidisciplinary approach.

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Acknowledgements

Mr. Kelvin Wong Siu Hing, United Christian Hospital, is acknowledged for his help with statistical analysis.

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Authors and Affiliations

  1. Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong

    Janice J. C. Cheung

  2. Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR, Hong Kong

    Shasha Liu & Kenneth K. W. Li

  3. Wu Ho Loo Ning Cataract Centre, Tseung Kwan O Hospital, 2 Po Ning Path, Tseung Kwan O, Hong Kong SAR, Hong Kong

    Kenneth K. W. Li

Authors
  1. Janice J. C. Cheung
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  2. Shasha Liu
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Correspondence to Kenneth K. W. Li.

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The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the local institutional research ethics committee, Institutional Review Board of the Hospital Authority Kowloon East Cluster (reference number KC/KE-17-0117/ER-4). The study firmly adhered to the tenets of the 1964 Helsinki Declaration and its later amendments. For this type of study, formal consent is not required.

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Cheung, J.J.C., Liu, S. & Li, K.K.W. Phacoemulsification cataract surgery in patients receiving novel oral anticoagulant medications. Int Ophthalmol 39, 623–630 (2019). https://doi.org/10.1007/s10792-018-0862-x

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  • DOI: https://doi.org/10.1007/s10792-018-0862-x

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