Management of Apixaban (Eliquis) Before Cataract Surgery
For cataract surgery, apixaban (Eliquis) should be discontinued for 1 day before the procedure as it is classified as a low-to-moderate bleeding risk procedure. 1
Anticoagulation Management Guidelines for Cataract Surgery
Recommended Discontinuation Protocol
- For cataract surgery (low-to-moderate bleeding risk):
Factors Affecting Discontinuation Timing
- Renal function:
- Normal or mild impairment (CrCl ≥50 mL/min): 1 day off before surgery
- Moderate impairment (CrCl 30-50 mL/min): Consider extending to 2 days 1
Resumption After Surgery
- Resume apixaban 24 hours after cataract surgery once adequate hemostasis has been established 3
- For low bleeding risk procedures like cataract surgery, anticoagulation can typically be resumed within 24 hours 2
Evidence Analysis
The 2022 American College of Chest Physicians (ACCP) guidelines provide the most recent and authoritative recommendations, stating that apixaban should be discontinued for 1 day before low-to-moderate bleeding risk procedures 1. This is particularly relevant as cataract surgery is generally considered a low bleeding risk procedure.
While older guidelines from 2012 suggested longer discontinuation periods (2-3 days) 1, the more recent ACCP guidelines from 2022 provide updated recommendations based on newer evidence.
The FDA label for apixaban states that it should be discontinued at least 24 hours prior to elective surgery or invasive procedures with a low risk of bleeding 3, which aligns with the ACCP guidelines.
Special Considerations
Alternative Approaches
- Some studies suggest that continuing anticoagulation during cataract surgery may be safe when using topical or intracameral anesthesia rather than injected anesthesia 4, 5
- However, the most recent guidelines still recommend a 1-day discontinuation period for apixaban
Monitoring and Precautions
- Monitor for bleeding every 30 minutes initially after the procedure 2
- Consider local hemostatic measures if needed 2
- Avoid strenuous physical activities for 48 hours after the procedure 2
Common Pitfalls to Avoid
- Don't discontinue for too long: Extended discontinuation increases thrombotic risk
- Don't use bridging anticoagulation: Bridging with heparin is not recommended and may increase bleeding risk 2, 3
- Don't restart too early: Ensure adequate hemostasis before resuming apixaban
By following these evidence-based recommendations, you can minimize both bleeding complications during cataract surgery and thrombotic events from extended anticoagulant interruption.