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.