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Safety of cataract surgery in patients treated with the new oral anticoagulants (NOACs)

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Abstract

Purpose

To evaluate the safety of phacoemulsification of cataract in patients taking new oral anticoagulants (NOACs).

Methods

In a prospective case series, consecutive patients on NOACs (dabigatran, rivaroxaban, or apixaban) who were referred for uncomplicated cataract surgery to the eye institute underwent a thorough ophthalmological and hematological evaluation. Rivaroxaban and apixaban anti-factor Xa tests, and diluted thrombin time for dabigatran, were used for monitoring anticoagulation levels in blood. Blood was drawn for these tests just prior to surgery and at a peak level of the drug at about 4 h post-surgery (2 h after the drug was given). All surgeries were videotaped and patients were examined at 1 and 7 days after the operation. The main outcome measures included assessment of intra-operative, postoperative ocular bleeding, and other related complications.

Results

Thirty-five eyes of 25 unrelated patients ranging in age from 63 to 92 years (mean 77.6 years) underwent phacoemulsification. Intra-operative bleeding was observed in 5 eyes from the conjunctiva or limbus at the main incision site. No intraocular bleeding occurred. No hemorrhagic complications were observed during the 1-week follow-up. According to anti-factor Xa levels prior to surgery and following surgery, 85% of the patients were on therapeutic levels of NOACs.

Conclusions

Clear corneal incision phacoemulsification performed under topical anesthesia can be safely performed in simple cases of cataract without discontinuing NOAC treatment.

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Authors and Affiliations

  1. Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv University, Tel Hashomer, Israel

    Irina S. Barequet, Tzukit Zehavi-Dorin, Nirit Bourla & Joseph Moisseiev

  2. Institute of Thrombosis & Hemostasis, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv, University, Tel Hashomer, Israel

    Ilia Tamarin & Ophira Salomon

Authors
  1. Irina S. Barequet
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  2. Tzukit Zehavi-Dorin
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  3. Nirit Bourla
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  5. Joseph Moisseiev
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Correspondence to Irina S. Barequet.

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All procedures performed were in accordance with the ethical standards of the (Review Board of the Sheba Medical Center) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

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Informed consent was obtained from all individual participants included in the study.

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Barequet, I.S., Zehavi-Dorin, T., Bourla, N. et al. Safety of cataract surgery in patients treated with the new oral anticoagulants (NOACs). Graefes Arch Clin Exp Ophthalmol 257, 2671–2676 (2019). https://doi.org/10.1007/s00417-019-04488-8

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