title: Phacoemulsification of cataract in patients receiving Coumadin therapy: ocular and hematologic risk assessment.
abstract: OBJECTIVE
  To assess the risks of intra- and postoperative bleeding tendency associated with uncomplicated cataract surgery by phacoemulsification in patients receiving Coumadin treatment.
  
  
  METHODS
  Prospective, nonrandomized, interventional, consecutive case series.
  
  
  METHODS
  Sixty-three consecutive patients underwent cataract extraction with lens implantation in 75 eyes. All patients were receiving Coumadin therapy at the time of surgery, and nine patients (14.3%) were also taking antiaggregants. The operations were performed by phacoemulsification technique under topical anesthesia. All patients underwent a hemostatic work-up before intervention. Structured questionnaires were completed by the surgeon immediately after the operation. In 18 (24%) eyes, the surgery was videotaped, and the tapes were reviewed subsequently for any bleedings by an independent observer.
  
  
  RESULTS
  Twelve patients (19%) underwent surgery in both eyes, not simultaneously. The mean prothrombin time international normalized ratio (INR) was 2.03 at the time of the surgery. No significant intraoperative bleeding occurred. Four (6.3%) patients had minor postoperative ocular bleeding. A microscopic hyphema and a dot retinal hemorrhage were each seen in one eye on the first postoperative day, and small iris hemorrhages were identified in two additional eyes at the one-week visit. All bleedings disappeared within one week without affecting the visual acuity. The mean INR of the four patients with minor bleedings was 2.1.
  
  
  CONCLUSIONS
  Cataract surgery by phacoemulsification in uncomplicated eyes can be performed safely in patients receiving Coumadin treatment. However, a large clinical trial is required to assess the safety of continuous Coumadin treatment associated with phacoemulsification in eyes with complicated cataract.
authors.affiliation: Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel. ibarequet@hotmail.com
authors.forename: Irina S
authors.initials: IS
authors.lastname: Barequet
authors.forename: Dan
authors.initials: D
authors.lastname: Sachs
authors.forename: Ayelet
authors.initials: A
authors.lastname: Priel
authors.forename: Yael
authors.initials: Y
authors.lastname: Wasserzug
authors.forename: Uri
authors.initials: U
authors.lastname: Martinowitz
authors.forename: Joseph
authors.initials: J
authors.lastname: Moisseiev
authors.forename: Ophira
authors.initials: O
authors.lastname: Salomon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D016063:Blood Loss, Surgical; D005130:Eye Hemorrhage / Q000209:etiology*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D019106:Postoperative Hemorrhage; D011446:Prospective Studies; D011517:Prothrombin Time; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin