Ophthalmologic Procedures

Thromboembolic Risks

For most procedures, perioperative management will be driven by thromboembolic risk.

Risk of holding anti-thrombotic agents perioperatively increases the risk of thromboembolic events, and does not significantly increase the risk of bleeding.

Anticoagulants should not be discontinued without consultation with the provider who is managing the anticoagulants to avoid significant issues.

Bleeding Risks

Complications with a sharp needle or a sub-Tenon cannula in patients taking warfarin (6.2% versus 4.3%) has been largely related to subconjunctival hemorrhage rather than sight-threatening hemorrhagic complications.

General Recommendations for Pre-Procedure Warfarin Management

Very low risk:  Cataract

  • Aspirin: no hold
  • Warfarin: no hold to 3 day hold
  • Clopidogrel/other antiplatelets:  no hold to 5 day hold

Low risk: Cornea and pterygium

  • Warfarin: no hold to 3 day hold
  • Clopidogrel/other antiplatelets and aspirin: no hold to 5 day hold

Intermediate risk: Retinal, Glaucoma, Plastics, PKP

  • Warfarin: 3-5 day hold
  • Clopidogrel/other antiplatelets: 5-7 day hold
  • Aspirin:  10 day hold

High risk: Orbital decompression, Lower lid Blepharoplasty, Repair blowout fractures, Dacrocystorhinostomy, Strabismus 

  • Warfarin: 5 day hold
  • Clopidogrel/other antiplatelets and aspirin: 7-10 day hold








References:

R. Batra, A. Maino, S.W. Ch'ng and I.B. Marsh, Perioperative management of anticoagulated patients having cataract surgery; national audit of current practice of members of the Royal College of Ophthalmologists, J Cataract Refract Surg 35 (2009), pp. 1815–1820.
 

J.D. Benzimra, R.L. Johnston, P. Jaycock, P.H. Galloway, G. Lambert, A.K. Chung, T. Eke and J.M. Sparrow, The Cataract National Dataset electronic multicentre audit of 55 567 operations: antiplatelet and anticoagulant medications; the EPR User Group

 

Special thanks to Carol Matthews, NP for her expert guidance.