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International Ophthalmology
Published in: International Ophthalmology 1/2024

Open Access 01-12-2024 | Direct Oral Anticoagulant | Original Paper

Effect of direct oral anticoagulants on bleeding during and after cataract surgery

Authors: Anat Maytal, Hadar Naidorf Rosenblatt, Reut Rotem, Fani Segev

Published in: International Ophthalmology | Issue 1/2024

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Abstract

Purpose

To assess the risk for intraoperative and postoperative ocular bleeding associated with direct oral anticoagulant treatment in patients undergoing phacoemulsification surgery.

Methods

Consecutive patients had phacoemulsification and intraocular lens implantation while taking uninterrupted direct oral anticoagulants (dabigatran, rivaroxaban, or apixaban). Gender and age-matched patients without antithrombotic therapy were used as the control group. Patients were examined one week postoperatively. Intraoperative and postoperative hemorrhagic and non-hemorrhagic complications were assessed.

Results

Forty patients (56 eyes) on direct oral anticoagulants and 120 patients (172 eyes) without anticoagulation, at a mean age of 77 years, had phacoemulsification. There was no significant difference between the groups in the rate of intraoperative and postoperative bleeding. One eye (1.8%) in the treatment group and 3 eyes (1.7%) in the control group had hyphema (p = 0.72). No patient had thromboembolic event during or after surgery.

Conclusions

Cataract surgery was safely performed while continuing direct oral anticoagulation.
Literature
1.
Blum RA, Lindfield D (2016) Direct oral anticoagulant drugs (DOAC). J Cataract Refract Surg 42:171–172CrossRefPubMed
2.
Ing E, Douketis J (2014) New oral anticoagulants and oculoplastic surgery. Can J Ophthalmol 49:123–127CrossRefPubMed
3.
Ferrandis R, Castillo J, de Andrés J, Gomar C, Gómez-Luque A, Hidalgo F et al (2013) The perioperative management of new direct oral anticoagulants: a question without answers. Thromb Haemost 110:515–522CrossRefPubMed
4.
Pollack CV Jr, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA et al (2015) Idarucizumab for dabigatran reversal. N Engl J Med 373:511–520CrossRefPubMed
5.
6.
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151CrossRefPubMed
7.
Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365:981–992CrossRefPubMed
8.
Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W et al (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365:883–891CrossRefPubMed
9.
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH et al (2012) Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e326S-e350SCrossRefPubMedPubMedCentral
10.
Katz J, Feldman MA, Bass EB, Lubomski LH, Tielsch JM, Petty BG et al (2003) Study of medical testing for cataract surgery team. Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. Ophthalmology 110:1784–1788CrossRefPubMed
11.
Benzimra JD, Johnston RL, Jaycock P, Galloway PH, Lambert G, Chung AK et al (2009) The cataract national dataset electronic multicentre audit of 55567 operations: antiplatelet and anticoagulant medications. Eye 23:10–16CrossRefPubMed
12.
Eriksson A, Koranyi G, Seregard S, Philipson B (1998) Risk of acute suprachoroidal hemorrhage with phacoemulsification. J Cataract Refract Surg 24:793–800CrossRefPubMed
13.
Rotenstreich Y, Rubowitz A, Segev F, Jaeger-Roshu S, Assia EI (2001) Effect of warfarin therapy on bleeding during cataract surgery. J Cataract Refract Surg 27:1344–1346CrossRefPubMed
14.
Kobayashi H (2010) Evaluation of the need to discontinue antiplatelet and anticoagulant medications before cataract surgery. J Cataract Refract Surg 36:1115–1119CrossRefPubMed
15.
Kumar N, Jivan S, Thomas P, McLure H (2006) Sub-Tenon’s anesthesia with aspirin, warfarin, and clopidogrel. J Cataract Refract Surg 32:1022–1025CrossRefPubMed
16.
Royal college of ophthalmologists. Cataract surgery guidelines. September 2010. London, UK, scientific department, the royal college of ophthalmologists, 2010.
17.
Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M (2006) Visual acuities “hand motion” and “counting fingers” can be quantified with the Freiburg visual acuity test. Invest Ophthalmol Vis Sci 47:1236–1240CrossRefPubMed
18.
Sun MT, Wood MK, Chan W, Selva D, Sanders P, Casson RJ et al (2017) Risk of intraocular bleeding with novel oral anticoagulants compared with warfarin: a systematic review and meta-analysis. Jama Ophthalmol 135:864–870CrossRefPubMedPubMedCentral
19.
Uyhazi KE, Miano T, Pan W, VanderBeek BL (2018) Association of novel oral antithrombotics with the risk of intraocular bleeding. JAMA Ophthalmol 136:122–130CrossRefPubMed
20.
Healey JS, Eikelboom J, Douketis J, Wallentin L, Oldgren J, Yang S et al (2012) Periprocedural bleeding and thromboembolic events with dabigatran compared to warfarin: results from the RE-LY randomized trial. Circulation 126:343–348CrossRefPubMed
21.
Patel R, De Klerk T (2019) Novel oral anticoagulants in cataract surgery - moving towards a national consensus regarding perioperative continuation. Eye 33:1820–1820CrossRefPubMedPubMedCentral
22.
Cheung J, Liu S, Li K (2018) Phacoemulsification cataract surgery in patients receiving novel oral anticoagulant medications. Int Ophthalmol 39:623–630CrossRefPubMed
23.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) ESC Scientific Document Group 2016. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962CrossRefPubMed
24.
25.
Kupelian V, McVary KT, Kaplan SA, Hall SA, Link CL, Aiyer LP et al (2009) Association of lower urinary tract symptoms and the metabolic syndrome: results from the Boston Area Community Health Survey. J Urol 182:616–624CrossRefPubMedPubMedCentral
26.
Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 31:664–673CrossRefPubMed
27.
Desco MC, Navea A, Ferrer E, Menezo JL (2005) Effect of prophylactic brimonidine on bleeding complications after cataract surgery. Eur J Ophthalmol 15:228–232CrossRefPubMed
28.
Ucar F, Yener HI (2022) Can bleeding in trabeculectomy be decreased? Effectiveness of brimonidine pre-treatment. Eur J Ophthalmol 32:3476–3481CrossRefPubMed
29.
Doherty JU, Gluckman TJ, Hucker WJ, Januzzi JL, Ortel TL, Saxonhouse SJ et al (2017) 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the American college of cardiology clinical expert consensus document task force. J Am Coll Cardiol 69:871–898CrossRefPubMed
30.
Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J et al (2013) European Heart Rhythm Association. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 15:625–651CrossRefPubMed
Metadata
Title
Effect of direct oral anticoagulants on bleeding during and after cataract surgery
Authors
Anat Maytal
Hadar Naidorf Rosenblatt
Reut Rotem
Fani Segev
Publication date
01-12-2024
Publisher
Springer Netherlands
Published in
International Ophthalmology / Issue 1/2024
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI
https://doi.org/10.1007/s10792-024-02944-x

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