Posters

Management of direct oral anticoagulants during cataract surgery: a review of risk factors and complications

Poster Details

First Author: A.Hajjar Sese UK

Co Author(s):    D. Shahnazaryan   C. Igwe   S. Jones              

Abstract Details

Purpose:

To review the risk factors, the incidence of intraoperative and postoperative complications, and therapeutic interventions in patients undergoing cataract surgery while on Direct Oral Anticoagulants (DOAC) such as Dabigatran, Rivaroxaban, Edoxaban and Apixaban. Patients undergoing cataract surgery without anticoagulation (AC) were established as a control group.

Setting:

Ophthalmology Department, King's College Hospital NHS Foundation Trust, London, UK.

Methods:

Data were obtained from a retrospective review of cataract surgeries performed from January 2016 to January 2018 on patients that were on DOAC treatment at the time of the surgery. Combined procedures such as vitreoretinal, glaucoma and corneal transplantation surgeries as well as patient with known haemorrhagic disorders were excluded. Intraoperative and postoperative complications, specifically haemorrhagic complications were recorded.

Results:

We have identified 43 cataract surgeries performed on patients taking DOACs. Age and sex-matched control group of 43 patients not on AC at the time of surgery were also included in the study. In the DOAC group, 29 cases were performed under subtenon´s (ST), 13 under topical, and 1 under general anaesthesia (GA). There was one (2.3%) case of self-limiting subconjunctival haemorrhage following ST anaesthesia. No sight-threatening haemorrhagic complications were reported in either group.

Conclusions:

With increasing age, patients undergoing cataract surgery often have co-morbidities requiring AC therapy. DOACs are a relatively new group of anticoagulants and currently, there are no known guidelines regarding the perioperative use of DOACs in cataract surgery. It is critical for an ophthalmic surgeon to balance the risks of serious haemorrhagic complications of cataract surgery against the risk of thromboembolic events. A multi-disciplinary approach is recommended for complex cases. In our study, perioperative use of DOACs was safe and was not associated with an increased risk of haemorrhagic complications.

Financial Disclosure:

None