Cataract surgery is often safely performed while patients remain on warfarin or direct oral anticoagulants (DOACs), with individualised planning.
General approach
The goal is to avoid clotting events while minimising surgical bleeding.
- Checking recent INR for warfarin users to ensure it is within the target range
- Continuing DOACs at usual doses in many routine cases
- Preferring topical or sub‑Tenon’s anaesthesia to avoid needle injections near the eye
- Monitoring for minor subconjunctival bleeding, which usually settles without issue
- Coordinating with prescribing doctors for high‑risk cardiovascular patients
When regimen adjustments may be needed
Some situations justify dose timing or temporary changes.
- Very high INR or a history of significant bleeding
- Complex ocular surgery or combined procedures with greater bleeding risk
- Renal impairment affecting DOAC clearance
- Advice to delay or skip one dose before surgery in selected patients
- Documented plan for restarting full anticoagulation after the operation
