Research has found that patients can be on blood thinner medication before and after their cataract surgery without any serious complications. Older patients and people with a history of heart problems might have a higher risk for side effects.
Cataract Surgery & Blood Thinners
For most patients, cataract surgery is a simple, easy, and uncomplicated procedure. As with any surgical procedure, there is always the chance of an issue, especially when it comes to elderly patients.
There is some concern about taking blood thinners before eye surgery. Researchers have studied whether antiplatelets or anticoagulants will affect the outcome of the surgery or otherwise interfere with the surgical process. A 2003 study published in the Journal of Family Practice noted that “there was no increased risk of” feared complications, such as stroke or other blood clotting effects, in people who were routine users of blood thinners and discontinued that use compared with patients who continued their use.
However, the researchers did determine that there was some amount of risk for myocardial (the muscular tissue of the heart) events among users who continued to take their blood thinners. This might have been due to patients having a higher likelihood of an obstruction of a blood vessel due to a dislodged blood clot.
The researchers concluded that the risk of damage to the eye was not higher in patients who continued their blood thinner intake before their surgery
A study out of Hartford Hospital’s Eye Surgery Center found that patients taking their blood thinner medications could continue to do so when receiving eye nerve blocks for surgical procedures on their eyes. Nerve blocks are administered via injection, and they prevent blinking and other involuntary responses, effectively keeping the eye as still as possible during surgery. Doctors had been concerned if people needing eye surgery who were taking blood thinners could receive the nerve block without discontinuing their medication.
The doctors at the eye surgery center took cataract surgery into account during their study. They noted that many of their patients needed the procedure while still taking blood thinners for other medical conditions, some of which were quite serious. Among the medications was Xarelto (rivaxoaban), an FDA-approved prescription blood thinner that can treat and prevent blood clots, reducing the risks of strokes, deep vein thrombosis, and pulmonary embolisms.
The study, consisting of over 11,000 patients, found that “nerve blocks are incredibly safe” when administered to patients taking blood thinners. Patients did not move their eyes and felt no sensation in their eyes, which allowed doctors to conduct the cataract surgery under ideal conditions.
There was a rare complication found in 0.018 percent of cases, which was a retrobulbar hematoma (bleeding behind the eye). While the development of retrobulbar hematoma occurs at a rate of about 1 to 3 percent in the general population, the incidence of this happening during cataract surgery due to blood thinners being present was less than 100 times that rate.
While being on blood thinners during cataract surgery is typically very safe, the chances of any issues (either during or after surgery) rise with the age of the patient.
Half of people who turn 80 years old will have developed cataracts, meaning cataract surgery is one of the most common surgeries performed on older people. Many of these people might be on blood thinners to help with other medical problems, as blood thinners can be safely prescribed to people into their 90s. This might contribute to the incidence of any problems with the interaction of blood thinners and nerve blocks.
Overall, blood thinners do not impede cataract surgery. The risks are relatively small, but an elderly patient should talk to their doctor about the likelihood of complications.
Cataract Surgical Rates. (2017). Community Eye Health.
Discontinuing Aspirin or Warfarin Optional Before Cataract Surgery. (December 2003). MDedge.
New Study Shows Safety in Taking Blood Thinners Before Eye Surgery. (June 2019). Health News Hub.
Administering an Eye Anaesthetic: Principles, Techniques, and Complications. (March 2008). Community Eye Health.
What Is Xarelto? Xarelto.
Potential Risks and Complications of Cataract Surgery. (November 2019). Verywell Health.