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Discontinuing aspirin or warfarin optional before cataract surgery

J Fam Pract. 2003 December;52(12):919-941
By
Anne Mounsey, MD
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  • BACKGROUND: There is controversy over whether the risks of adverse events due to stopping anticoagulation and antiplatelet therapy prior to cataract surgery outweigh the benefits of fewer hemorrhagic events. This study compared adverse outcomes related to continued use or discontinuation of anticoagulant and antiplatelet therapy in patients who had cataract surgery.
  • POPULATION STUDIED: This study included 19,354 patients undergoing cataract surgery recruited from 9 centers in the United States and Canada: private practices in ambulatory surgery centers, academic centers, and community hospitals.
  • STUDY DESIGN AND VALIDITY: This was a prospective cohort study. Eligible patients were characterized as users and nonusers of aspirin or warfarin. Those who did not use aspirin within 4 days or warfarin within 10 days of surgery were considered nonusers. Overall, 76.7% of patients did not routinely use aspirin, 5.2% discontinued their use of aspirin before surgery, and 18% continued to use aspirin throughout the surgery. Most (96.1%) patients did not routinely use warfarin, 1.1% discontinued their use of warfarin, and 2.8% continued to use it throughout the surgery.
  • OUTCOMES MEASURED: The intraoperative and postoperative (within 7 days) outcomes assessed were retrobulbar hemorrhage, vitreous or choroidal hemorrhage, hyphema, transient ischemicattack, stroke, deep vein thrombosis, and myocardial infarction or myocardial ischemia.
  • RESULTS: There was no increased risk of stroke, transient ischemic attacks, or thromboembolic events in routine users of aspirin or warfarin who discontinued use compared with those who continued. The risk of myocardial events and transient ischemic attacks was higher among routine users of aspirin or warfarin who continued to use. This increase rate probably occurred because these patients had a higher baseline risk of a thromboembolic event. Risk of ocular hemorrhage was no higher in those patients who continued aspirin or warfarin before surgery.
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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.

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