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The Cataract National Dataset electronic multicentre audit of 55,567 operations: antiplatelet and anticoagulant
J D Benzimra1, R L Johnston, P Jaycock
1Gloucestershire Eye Department, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK.
Insights
Patients on clopidogrel or warfarin experienced more minor complications during cataract surgery local anesthesia. However, these medications did not increase sight-threatening or major bleeding complications.
Area of Science:
- Ophthalmology
- Pharmacology
- Public Health
Background:
- Cataract surgery is a common procedure with a low complication rate.
- Anticoagulant and antiplatelet medications are frequently used in patients undergoing surgery.
- Understanding the impact of these medications on surgical outcomes is crucial for patient safety.
Purpose of the Study:
- To determine the prevalence of aspirin, dipyridamole, clopidogrel, and warfarin use in patients undergoing cataract surgery.
- To compare local anesthetic and intraoperative complication rates between users and non-users of these medications.
Main Methods:
- Analysis of anonymized electronic patient records from the Cataract National Dataset.
- Inclusion of 48,862 cataract operations from eight NHS Trusts between 2001 and 2006.
- Comparison of complication rates based on the use of specific anticoagulant/antiplatelet drugs.
Main Results:
- Prevalence: Aspirin (28.1%), warfarin (5.1%), clopidogrel (1.9%), dipyridamole (1.0%).
- Increased minor complications (local anesthetic block, subconjunctival hemorrhage) observed with clopidogrel and warfarin use.
- No significant increase in sight-threatening local anesthetic complications or major operative hemorrhagic complications.
Conclusions:
- Clopidogrel and warfarin use are associated with a higher incidence of minor local anesthetic complications.
- These medications do not appear to significantly increase the risk of sight-threatening complications or major operative bleeding during cataract surgery.
- Risk-benefit assessment for continuing these medications perioperatively should consider the increased risk of minor complications.
Aims:
This study aims to establish the prevalence of aspirin, dipyridamole, clopidogrel, and warfarin use in patients undergoing cataract surgery, and to compare local anaesthetic and intraoperative complication rates between users and non-users.
Methods:
The Cataract National Dataset was remotely extracted and anonymised on 55,567 operations at 12 NHS Trusts using electronic patient records (EPRs) between 2001 and 2006.
Results:
This report analyses 48,862 of the 55,567 operations from the eight centres, which routinely recorded a drug history. In all, 28.1% of the 48,862 patients were taking aspirin, 5.1% warfarin, 1.9% clopidogrel, and 1.0% dipyridamole. The recording of any complication of a sharp needle or subtenon's cannula local anaesthetic block was increased in patients taking clopidogrel, 8.0% (P<0.0001) or warfarin, 6.2% (P=0.0026) vs non-users, 4.3%, but no increase in potentially sight-threatening complications was identified. The incidence of subconjunctival haemorrhage was increased in patients taking clopidogrel, 4.4% (P<0.0001) or warfarin, 3.7% (P<0.0001) vs non-users, 1.7%. The recording of any operative complication was increased in those taking clopidogrel, 7.3% (P=0.0002) vs non-users, 4.4%, but the haemorrhagic operative complications of choroidal/suprachoroidal haemorrhage and hyphaema were not significantly increased. The non-haemorrhagic complication of posterior capsular rupture (PCR) was increased in those taking clopidogrel, 3.23% (P=0.0057) vs non-users, 1.77%.
Conclusions:
Clopidogrel or warfarin use was associated with a significant increase in minor complications of sharp needle and subtenon's cannula local anaesthesia but was not associated with a significant increase in potentially sight-threatening local anaesthetic or operative haemorrhagic complications.
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