Cheung Janice J C, Liu Shasha, Li Kenneth K W
Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong.
Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR, Hong Kong.
Int Ophthalmol. 2019 Mar;39(3):623-630. doi: 10.1007/s10792-018-0862-x. Epub 2018 Feb 13.
An increasing number of patients are taking novel oral anticoagulant (NOAC) medication, making perioperative management in phacoemulsification surgery an important issue. This study reports the haemorrhagic complications of NOAC in phacoemulsification surgery.
Retrospective case study over a 4-year period.
Consecutive cases receiving NOAC during the time of phacoemulsification were reviewed. Patients were either advised to continue medications (continued group) or withhold medications before surgery (withheld group).
Details including patient demographics, preoperative assessment, postoperative outcome and intraoperative, postoperative and systemic complications were recorded.
A total of 20,100 cases of phacoemulsification were performed. Of which, 66 cases were found to be on NOAC (0.33%). This included 66 eyes of 53 patients, with 42 continued and 24 withheld medications before surgery. There was no statistically significant difference between the two groups in demographics, cataract risk factors, baseline renal function, clotting profile, type of NOAC, incision size, phacoemulsification energy, preoperative and postoperative visual acuity. There was also no significant difference in intraoperative, postoperative and systemic complications (p = 1.00 and 0.53, Fischer's exact test). None of the patients in the continued group had postoperative complications; two cases in the withheld group receiving retrobulbar anaesthesia had bruising and subconjunctival haemorrhage after resumption of NOAC (p = 0.13, Fischer's exact test).
The present study found no difference in haemorrhagic complications between cases continuing and withholding NOAC during phacoemulsification. Nevertheless, the potential risks and benefits to continue or withhold NOAC perioperatively should be carefully considered via a multidisciplinary approach.
越来越多的患者正在服用新型口服抗凝药（NOAC），这使得白内障超声乳化手术的围手术期管理成为一个重要问题。本研究报告了白内障超声乳化手术中NOAC的出血并发症。
为期4年的回顾性病例研究。
对白内障超声乳化手术期间接受NOAC治疗的连续病例进行回顾。患者被建议继续用药（继续用药组）或在手术前停药（停药组）。
记录包括患者人口统计学、术前评估、术后结果以及术中、术后和全身并发症等详细信息。
共进行了20100例白内障超声乳化手术。其中，66例（0.33%）正在服用NOAC。这包括53例患者的66只眼，其中42例在手术前继续用药，24例停药。两组在人口统计学、白内障危险因素、基线肾功能、凝血指标、NOAC类型、切口大小、超声乳化能量、术前和术后视力方面无统计学显著差异。术中、术后和全身并发症也无显著差异（p = 1.00和0.53，Fisher精确检验）。继续用药组的患者均无术后并发症；停药组中接受球后麻醉的2例患者在恢复使用NOAC后出现瘀斑和结膜下出血（p = 0.13，Fisher精确检验）。
本研究发现白内障超声乳化手术期间继续使用和停用NOAC的病例在出血并发症方面无差异。然而，应通过多学科方法仔细考虑围手术期继续或停用NOAC的潜在风险和益处。
