Chronic antithrombotic therapy in cataract surgery: How much evidence do we have?

Cataract surgery is a procedure performed on a high number of patients in prolonged antithrombotic treatment.1 Over 28% of these patients take aspirin, 2% are in treatment with clopidogrel and over 5% are anticoagulated.2 It is well known that interrupting the use of anticoagulants during surgery could increase the risk of thromboembolism. For example, the annual cerebrovascular accident risk in a patient with auricular fibrillation without anticoagulant treatment is of 5%. Hemorrhage is a fearful complication in patients who are on antiplatelet/anticoagulant treatment and undergo surgical procedures. Particularly in cataract surgery, subconjunctival hemorrhage is the most frequent hemorrhagic adverse event, while suprachoroidal, retrobulbar, peribulbar, vitreous and expulsive hemorrhages are observed with less frequency, together with hemorrhages in the iris, anterior chamber, and palpebral ecchymosis.2 Consequently, surgeons must choose between facing the risk of hemorrhages against the probability of antithrombotic events occurring due to the interruption of the appropriate therapy. Even though cataract surgery is considered to be a nonvascular procedure and as slight bleeding is itself limited in most cases when the intervention is performed by an expert surgeon, the potential risk of bleeding continues to be cause of discussion in everyday practice.1 However, many surgeons prefer to suspend antithrombotic therapy prior to cataract surgery despite the risk of thrombotic events. In the majority of cases, the problem is resolved on the basis of the surgeon’s personal experience or with the support of other medical specialties (for example cardiology or hematology) with the ensuing increase in cost and time. A comprehensive prospective study published by Katz et al.1 on the risks and benefits of chronic antithrombotic therapy in 19,283 patients who had cataract surgery concluded that the ocular hemorrhage risk was not greater in the group of patients that continued with the antithrombotic treatment, and that the risk of thrombotic events in patients