Safety of continuing warfarin therapy during cataract surgery: a systematic review and meta-analysis.

Abstract:

BACKGROUND:In patients who are receiving warfarin therapy and require cataract surgery, it may be possible to continue warfarin in the perioperative period but the safety of this management strategy has not been systematically evaluated. METHODS:We performed a systematic review of the literature to assess the safety (bleeding events) of continuing warfarin before and after cataract surgery. We included studies that enrolled patients undergoing cataract surgery who were anticoagulated with warfarin alone and that reported bleeding events as an outcome. Study quality was assessed using a validated form. Odds ratios and bleeding rates were pooled to give summary estimates of bleeding risk. RESULTS:We identified 11 studies (5 cohort and 6 case series) assessing bleeding risk associated with warfarin continuation during cataract surgery. Patients who continued warfarin had an increased risk for bleeding (odds ratio; 3.26; 95% confidence interval [CI]: 1.73-6.16). The overall incidence of bleeding (95% CI) was 10% (5-19). Almost all bleeding events were self-limiting and not significant, consisting of dot hyphemae or subconjunctival hemorrhages. No patient had compromised visual acuity related to a bleeding event. CONCLUSION:Patients who are receiving warfarin therapy and undergo cataract surgery without warfarin interruption have an increased risk for bleeding but such bleeds are not clinically significant. The low quality of studies assessed, however, precludes definitive conclusions as to the risk for bleeding in patients who continue warfarin around the time of cataract surgery.

journal_name

Thromb Res

journal_title

Thrombosis research

authors

Jamula E,Anderson J,Douketis JD

doi

10.1016/j.thromres.2009.01.007

subject

Has Abstract

pub_date

2009-07-01 00:00:00

pages

292-9

issue

3

eissn

0049-3848

issn

1879-2472

pii

S0049-3848(09)00027-9

journal_volume

124

pub_type

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