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

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. (c) 2009 Elsevier Ltd. All rights reserved.