Haemorrhagic complications following cataract and vitreoretinal surgery with sub-Tenon’s block in patients receiving non–vitamin K oral anticoagulant agents: A prospective audit

Abstract

There is a lack of data to support either continuation or interruption of non–vitamin K oral anticoagulants for cataract and vitreoretinal surgery. A prospective audit was undertaken of 291 patients undergoing cataract surgery or vitreoretinal surgery, predominantly under sub-Tenon’s block, while continuing these agents. The median time from last non–vitamin K oral anticoagulant dose to the insertion of sub-Tenon’s block was five hours. No patient required emergency reversal of anticoagulation. There were no sight-threatening complications in the immediate perioperative period, although two vitreoretinal patients (3.8%) had a moderate haemorrhagic complication on day five, and two cataract patients (0.8%) had a minor haemorrhagic complication on days one and 14 postoperatively. Despite continuing their non–vitamin K oral anticoagulants, three (1%) cataract patients had a moderate thromboembolic complication within the 30-day postoperative period. The risk of haemorrhagic complications associated with continuation of anticoagulation with non–vitamin K oral anticoagulants for cataract and vitreoretinal surgery is low, and this audit supports the continuation of non–vitamin K oral anticoagulants for our patients having cataract and vitreoretinal surgery.

Antiplatelets and Anticoagulants in Vitreoretinal Surgery: A Systematic Review

“…Grand et al [ 21 ] were the first to show that patients may successfully undergo vitreoretinal surgery while maintaining medications, such as rivaroxaban, apixaban, dabigatran, and prasugrel. The same results on the safety of not stopping NOAs were demonstrated afterward by various authors [ 13 , 14 , 19 ].…”

“…Guise et al [ 13 ], in 2022, aimed to gather a consensus on the opportunity of avoiding non-vitamin K oral anticoagulants (NOAs). A total of 291 patients were included in the study as they were taking these medications while having cataract surgery or vitreoretinal surgery, mostly under sub-Tenon’s anesthesia.…”