From the Guidelines
Coumadin (warfarin) typically does not need to be discontinued before cataract surgery. Most ophthalmologists now perform cataract surgery without interrupting anticoagulation therapy, including warfarin, as long as the INR (International Normalized Ratio) is within the therapeutic range, usually between 2.0 and 3.0 [ 1 ]. Patients should continue taking their prescribed warfarin dose as scheduled and should inform their surgeon about all medications they are taking. The surgeon will likely request a recent INR test (within 1 week of surgery) to ensure levels are appropriate.
Modern cataract surgery is minimally invasive, performed through tiny incisions that seal without sutures, resulting in minimal bleeding risk even for anticoagulated patients. The risk of thromboembolic events from discontinuing warfarin generally outweighs the small risk of bleeding complications during cataract surgery [ 1 ]. However, this recommendation may vary based on individual patient factors such as bleeding disorders or extremely high INR values, so patients should always follow their specific surgeon's instructions regarding medication management before surgery.
Some key points to consider include:
- The American College of Chest Physicians suggests continuing VKAs, like warfarin, around the time of cataract surgery instead of alternative strategies [ 1 ].
- Eye surgery, particularly for cataracts, is usually associated with very little bleeding and thus is frequently performed without alterations to antithrombotic treatment [ 1 ].
- Patients should continue their prescribed medication regimen and inform their surgeon of all medications being taken.
- A recent INR test is usually required to ensure levels are within the therapeutic range before surgery.
From the Research
Coumadin and Cataract Surgery
- The need to hold Coumadin (warfarin) prior to cataract surgery is a topic of discussion among medical professionals, with various studies providing insights into the risks and benefits of continuing or discontinuing warfarin therapy during this period 2, 3, 4.
- Research suggests that the risk of hemorrhage associated with cataract surgery is low if the international normalized ratio (INR) is within the therapeutic range, indicating that warfarin can be safely continued in patients undergoing cataract surgery 2, 4.
- A systematic review and meta-analysis found that patients who continued warfarin during cataract surgery had an increased risk of bleeding, but most bleeding events were self-limiting and not significant 3.
- Another study found that cessation or reduction of anticoagulation may lead to serious thromboembolic phenomena, highlighting the importance of careful consideration when deciding whether to hold warfarin prior to cataract surgery 4.
Risks and Benefits
- The risks of continuing warfarin during cataract surgery include an increased risk of bleeding, although most bleeding events are minor and self-limiting 3, 4.
- The benefits of continuing warfarin include reducing the risk of thromboembolic events, which can be serious and potentially life-threatening 2, 4.
- The decision to hold warfarin prior to cataract surgery should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 2, 3, 4.
Clinical Guidelines
- Clinical guidelines suggest that warfarin can be safely continued in patients undergoing cataract surgery, provided that the INR is within the therapeutic range 2, 4.
- However, the decision to continue or discontinue warfarin should be made in consultation with the patient's healthcare provider, taking into account the individual patient's risk factors and medical history 2, 3, 4.