Phacoemulsification Cataract Surgery in Patients Receiving Novel Oral Anticoagulant

Abstract

Purpose : To assess the risk of intraoperative and postoperative bleeding in patients receiving novel oral anticoagulation (NOAC) while undergoing phacoemulsification surgery.

Methods : A retrospective study reviewed the electronic records of consecutive patients receiving NOAC during the time of phacoemulsification surgery over a 4-year period (from January 2012 through to September 2016). Patients were either advised to stop medication before surgery (withheld group) or continue medication throughout the surgery (continued group). Details including patient demographics, preoperative assessment, surgical details, postoperative outcome and intraoperative, postoperative and systemic complications were all recorded.

Results : A total of 66 eyes of 53 patients were included, 42 continued and 24 withheld medication before surgery. There was no statistically significant difference between the two groups in demographics, cataract risk factors, baseline renal function and clotting profile, type of NOAC, wound size, phacoemulsification energy and pre-operative or post-operative visual acuity. There was also no significant difference in post-operative and systemic complications (p= 1.00 and 0.53, Fischer’s exact test). None of the patients in the continued group had post-operative complications; two cases in the withheld group had bruising and subconjunctival hemorrhage, which were self-limiting in nature (p=0.13, Fischer’s exact test). The only significant difference between the two groups was the mode of anesthesia (p = 0.01, Fischer’s exact test).

Conclusions : Continuation of NOAC medications during phacoemulsification surgery appears safe, with low risk of intraoperative and postoperative haemorrhagic complications. The choice to continue or withhold NOAC perioperatively should be balanced with potential benefit and risk with a multidisciplinary approach.