76 - 80 SBAs for the Final FRCA
Question 76
An 87 year old man is due to have elective cataract surgery under local anaesthesia.
He takes warfarin for his mechanical heart valve, with an INR target of 2.5-3.5
Which of the following is the best course of action?
- Perform the procedure under general anaesthesia
- Stop warfarin seven days prior to the operation and restart immediately after
- Continue warfarin and give an intraoperative dose of tranexamic acid
- Stop warfarin, assess INR and bridge with low molecular weight heparin
- Continue warfarin
Answer
- Continue warfarin
Antiplatelets and anticoagulants can continue as normal in the run up to cataract surgery.
The risk of a clot vastly outweighs the risk of a clinically important bleed.
General anaesthesia is high risk for this gentleman and should be avoided if possible.