From the Guidelines
You should not stop taking Eliquis (apixaban) before cataract surgery without consulting your ophthalmologist and the doctor who prescribed the medication, as most cataract surgeries can be safely performed while continuing Eliquis due to the minimal bleeding risk involved. When considering the management of antithrombotic therapy in the perioperative period, a pharmacokinetic-based approach can be used, taking into account the elimination half-lives of the direct oral anticoagulants (DOACs) like apixaban 1. Given that the half-life of apixaban is approximately 9 to 14 hours, withholding it for 1 full day before a low-to-moderate-bleed-risk procedure like cataract surgery may be sufficient, resulting in an acceptable residual anticoagulant effect for such procedures 1.
However, the decision to stop or continue Eliquis should be made on a case-by-case basis, considering the patient's individual risk factors for bleeding and thromboembolism. It's crucial to discuss all medications, complete medical history, and any previous bleeding issues with your doctors to make an informed decision at least one week before surgery 1. The management strategy might also include measuring DOAC levels before surgery in certain cases, although this approach has its practical limitations and questions regarding clinical utility 1.
After surgery, it's essential to follow your doctor's instructions carefully regarding when to resume Eliquis, as the timing can depend on the type of surgery and the patient's risk factors. Generally, for patients undergoing less invasive surgery, resuming a treatment-dose regimen the day after surgery or at least after 24 hours have elapsed is suggested, to allow sufficient time for wound hemostasis 1.
In summary, the approach to managing Eliquis in the context of cataract surgery should prioritize minimizing both the risk of bleeding and the risk of thromboembolic events, with a tailored strategy based on the latest clinical guidelines and the patient's specific clinical scenario.
From the FDA Drug Label
Apixaban tablets should be discontinued at least 48 hours prior to elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding [see Warnings and Precautions (5. 2)] . Apixaban tablets should be discontinued at least 24 hours prior to elective surgery or invasive procedures with a low risk of bleeding or where the bleeding would be non-critical in location and easily controlled.
Stopping Eliquis before cataract surgery:
- The decision to stop Eliquis (apixaban) before cataract surgery depends on the risk of bleeding associated with the procedure.
- Since cataract surgery is generally considered a procedure with a low risk of bleeding, Eliquis should be discontinued at least 24 hours prior to the surgery. 2
From the Research
Stopping Eliquis Before Cataract Surgery
- The decision to stop taking Eliquis (apixaban) before cataract surgery should be made in consultation with a healthcare provider, as it depends on various factors, including the patient's individual risk of bleeding and thromboembolism 3, 4.
- Some studies suggest that anticoagulants, including warfarin, can be safely continued during cataract surgery if the international normalized ratio (INR) is within the therapeutic range 3, 5.
- However, there is limited evidence available on the use of direct oral anticoagulants (DOACs) like Eliquis during cataract surgery, and no definitive recommendations can be made 3.
- Discontinuing anticoagulant or antiplatelet drugs before cataract surgery may increase the risk of thromboembolism, and the benefits of stopping these medications should be weighed against the potential risks 4, 5.
- Aspirin, an antiplatelet drug, can be safely continued in patients undergoing cataract surgery, and its discontinuation is usually not indicated 6.
- The management of patients taking antiplatelet agents, including clopidogrel, during surgery is more complex, and the decision to stop or continue these medications should be made on a case-by-case basis 7.