Abstract
Purpose :
Antithrombotics pose minimal risk of perioperative hemorrhagic events in ophthalmic surgery, while discontinuing these agents increases risk for cardiovascular events.1-4 Current evidence and guidelines support continuing antithrombotics for cataract surgery, regardless of anesthetic technique.5-10 Current trends of antithrombotic use during cataract surgery are not well described. This survey investigated practice patterns of perioperative systemic antithrombotic therapy among cataract surgeons in the Veterans Health Administration (VHA), the largest integrated health care system in the United States.
Methods :
A 17-question anonymous survey, consisting of multiple-choice questions, was e-mailed to VHA attending cataract surgeons using a listserv of comprehensive ophthalmologists provided by the Office of the National Ophthalmology Program Director.
Results :
Sixty-five cataract surgeons responded, representing approximately 30% of VHA ophthalmologists. Anticoagulants and antiplatelet agents were (a) never discontinued for cataract surgery by 55.4% (36/65) and 70.8% (46/65) of respondents, respectively; (b) discontinued more than half of the time by 4.6% (3/65) and 3.1% (2/65), respectively; and (c) always discontinued by 1.54% (1/65) and 1.54% (1/65), respectively. When using topical, peribulbar, retrobulbar and general anesthesia, 76.9% (50/65), 41.5% (27/65), 16.9% (11/65) and 69.2% (45/65) of respondents never discontinued antithrombotic agents, respectively. Among respondents who discontinued an antithrombotic agent (66.2%; 43/65), 16.3% (7/43) had observed a serious systemic vascular complication such as myocardial infarction or cerebral vascular accident.
Regarding practice experience, 9.2% of respondents had 0-5 years’ experience; 16.9% had 6-10 years; 32.3% had 11-20 years and 41.5% had >20 years. The number of cataract surgeries performed by the respondents were: 100-500 surgeries (7.7%), 501-1000 (6.2%), 1001-5000 (33.9%), 5001-10,000 (38.5%) and >10,0001 (13.9%).
Conclusions :
This survey suggests there is a significant percentage of VHA cataract surgeons who routinely discontinue antithrombotics prior to cataract surgery and choice of anesthesia may impact the decision to discontinue these agents. This data suggests that current VHA practice patterns do not uniformly align with evidence-based recommendations.3-10
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.