Management of Patients on Antithrombotic Medication for Cataract Surgery

Record the drug, dose, combination therapy and prescribing clinician. Distinguish antiplatelets (such as aspirin or clopidogrel), warfarin, and direct oral anticoagulants (DOACs).

Review coronary stents and their dates, stroke/TIA, prosthetic heart valves, venous thromboembolism and atrial fibrillation. Do not use a fixed time since diagnosis as permission to stop treatment.

Routine cataract surgery under topical or sub-Tenon anaesthesia differs from sharp-needle blocks and combined procedures. Assess the planned technique, bleeding history and ocular complexity.

RCOphth guidance for local-anaesthetic cataract surgery advises against routinely stopping anticoagulants. A higher-risk operation or anaesthetic technique requires a separate assessment.

Warfarin: establish that anticoagulation is within the patient’s prescribed therapeutic INR range, following local assessment protocols. An out-of-range INR needs review.

Antiplatelets: do not routinely stop aspirin for uncomplicated cataract surgery. Dual antiplatelet therapy, particularly after a coronary stent, needs coordinated review if any change is being considered.

DOACs: use the local cataract and anaesthesia protocol. If interruption is considered, the specific drug, renal function, bleeding risk and thrombotic indication affect the plan; there is no single stopping interval for everyone.

If a medication change is necessary, agree it with the prescribing clinician, anticoagulation service and surgical/anaesthetic team. Document whether treatment continues or is interrupted, and any restart instructions.

Explain the individual bleeding and thrombotic risks to the patient and record the discussion. The patient should not stop medication independently.