Mortality following cataract surgery in patients taking warfarin

Aims:  To study the long-term survival of warfarin users after cataract surgery. Methods:  This retrospective study involved 200 consecutive patients taking warfarin and 129 patients who had phacoemulsification at the same surgical sessions between January 2001 and December 2006. Their clinical characteristics and survival were retrieved from the hospital medical records and the electronic Patient Record of the Hospital Authority, Hong Kong. Standardized mortality ratios were computed and survival after cataract surgery was compared using the log rank test. Results:  Patients taking warfarin had shorter survival after cataract surgery (log rank test, p < 0.001); their standardized mortality ratios being 1.95 (95% confidence interval, 1.56 - 2.44). Survival in both groups appeared similar in the initial 2 years postoperatively, but a difference emerged thereafter. No difference in the causes of death was detected in the two groups (p = 0.33). Conclusions:  Patients taking warfarin had shorter survival after cataract surgery. This was likely an effect due to selection of healthier patients for surgery.

[1]  J. Katz,et al.  Routine preoperative medical testing for cataract surgery. , 2012, The Cochrane database of systematic reviews.

[2]  P. Friedmann,et al.  Predictors of mortality within 90 days of cataract surgery. , 2010, Ophthalmology.

[3]  Hiroshi Kobayashi.  Evaluation of the need to discontinue antiplatelet and anticoagulant medications before cataract surgery , 2010, Journal of cataract and refractive surgery.

[4]  I Kaiserman,et al.  Is cataract associated with cardiovascular morbidity? , 2010, Eye.

[5]  Nathan Congdon,et al.  Waiting time for cataract surgery and its influence on patient attitudes. , 2009, Investigative ophthalmology & visual science.

[6]  J. Douketis,et al.  Safety of continuing warfarin therapy during cataract surgery: a systematic review and meta-analysis. , 2009, Thrombosis research.

[7]  T. Roberts,et al.  Adverse medical events associated with cataract surgery performed under topical anaesthesia , 2008, Clinical & experimental ophthalmology.

[8]  A. Dick,et al.  Reduced mortality compared with national averages following phacoemulsification cataract surgery: a retrospective observational study , 2008, British Journal of Ophthalmology.

[9]  U. Martinowitz,et al.  Phacoemulsification of cataract in patients receiving Coumadin therapy: ocular and hematologic risk assessment. , 2007, American journal of ophthalmology.

[10]  H. Mclure,et al.  Sub‐Tenon's anesthesia with aspirin, warfarin, and clopidogrel , 2006, Journal of cataract and refractive surgery.

[11]  J. Katz,et al.  Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. , 2003, Ophthalmology.

[12]  Valentin Fuster,et al.  American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. , 2003, Circulation.

[13]  C. Owsley,et al.  The association between cataract and mortality among older adults , 2003, Ophthalmic epidemiology.

[14]  Y. Rotenstreich,et al.  Effect of warfarin therapy on bleeding during cataract surgery. , 2001, Journal of cataract and refractive surgery.

[15]  A. Konstantatos,et al.  Anticoagulation and Cataract Surgery: A Review of the Current Literature , 2001, Anaesthesia and intensive care.

[16]  M. Elder,et al.  Warfarin therapy and cataract surgery , 2000, Clinical & experimental ophthalmology.

[17]  J. Katz,et al.  The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery. , 2000, The New England journal of medicine.

[18]  E. Calenda,et al.  Topical anesthesia cataract surgery in patients with anticoagulant therapy. , 2000, Journal of cataract and refractive surgery.

[19]  Lubomski,et al.  The value of routine preoperative medical testing before cataract surgery , 2000, American journal of ophthalmology.

[20]  K. Baggesen,et al.  Mortality and causes of mortality among cataract-extracted patients. A 10-year follow-up. , 1999, Acta ophthalmologica Scandinavica.

[21]  T. Amemiya,et al.  Anticoagulation therapy and ocular surgery. , 1998, Ophthalmic surgery and lasers.

[22]  K. Carter,et al.  Phacoemulsification and lens implantation in patients treated with aspirin or warfarin , 1998, Journal of cataract and refractive surgery.

[23]  C. Roberts,et al.  Cataract surgery in anticoagulated patients , 1991, Journal of cataract and refractive surgery.

[24]  D. Ilstrup,et al.  Ocular surgery on patients receiving long-term warfarin therapy. , 1989, American journal of ophthalmology.

[25]  R. Caplan,et al.  Increased mortality rates after cataract surgery. A statistical analysis. , 1988, Ophthalmology.

[26]  A. Laplanche,et al.  Comparison of the mortality of a cohort with the mortality of a reference population in a prognostic study. , 1985, Statistics in medicine.

[27]  Valentin Fuster,et al.  American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. , 2003, Circulation.

[28]  P. Simcock,et al.  Management of the anticoagulated patient for ophthalmic surgery , 1993, Eye.