A study of the bleeding risk associated with continuation of anticoagulant and antiplatelet therapy during topical phacoemulsification cataract surgery

Introduction: India is fast becoming the cataract and cardiovascular disease capital of the world. Operating on cataract patients with cardiovascular co-morbidities and concurrent use of antithrombotic and anticoagulant drugs is a tricky proposition. Reducing cardiovascular event risk by continuing medication and preventing per-operative and post-operative bleeding complications during routine cataract surgery at the same time is any surgeon’s nightmare. This study was undertaken as follows: (i) assess per-op and post-op bleeding complications in patients on antithrombotic/anticoagulant therapy undergoing topical phacoemulsification cataract surgery; (ii) the visual gain and success of topical phacoemulsification cataract surgery with continuation of systemic antithrombotic/anticoagulant therapy; (iii) to study the cardiovascular co-morbidities in patients presenting for elective cataract surgery with reference to thromboembolic risk and its management. Materials and Methods: The present study was a prospective, nonrandomized, single-center case–control study conducted at the Institute of Ophthalmology, JNMCH, AMU, Aligarh. This study included 40 cases of antithrombotic/anticoagulant therapy undergoing topical phacoemulsification cataract surgery and 80 controls. Bleeding risk was assessed per-operatively and post-operatively by looking for any actual bleed and its management and was graded by the operating surgeon. Observation and Results: A total of 120 consecutive patients were operated on by clear corneal phacoemulsification under topical anesthesia, including 40 cases who were continued on their antithrombotic/anticoagulant medications and 80 age- and cataract grade-matched controls who were not taking any such medications. No peri-operative bleeding complication was noted in any patient. All patients had an excellent visual recovery. No cardiovascular event was noted in any patient per-operatively and post-operatively. Conclusion: This study has conclusively proven that cardiovascular morbidity and mortality risk can be reduced by continuing antithrombotic medications during topical phacoemulsification cataract surgery with no added risk of per-operative or post-operative bleeding complications and excellent visual gain.