title: Risk assessment of simple phacoemulsification in patients on combined anticoagulant and antiplatelet therapy.
abstract: OBJECTIVE
  To assess the safety of phacoemulsification cataract extraction in patients on combined anticoagulant and antiplatelet treatment.
  
  
  METHODS
  Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.
  
  
  METHODS
  Prospective interventional case series.
  
  
  METHODS
  Consecutive patients with simple cataract on combined anticoagulant (warfarin) and antiplatelet (aspirin or clopidogrel) treatment who were unable to discontinue the treatment because of a high risk for thromboembolic events were included. Patients had cataract extraction under topical anesthesia with a clear corneal incision (CCI), phacoemulsification, and implantation of a foldable posterior chamber intraocular lens. Prothrombin time-international normalized ratio and platelet functions were evaluated immediately before surgery. Patients were also examined 1 day and 7 days postoperatively. Intraoperative and postoperative ocular bleeding and other related complications were assessed.
  
  
  RESULTS
  Forty patients (51 eyes) with a mean age of 72 years (range 51 to 90 years) had phacoemulsification. Hemorrhagic complications were not observed at surgery or during the 1-week follow-up. Surgical complications included 1 rupture of the capsulorhexis and 1 implantation of a capsular tension ring due to partial zonulysis. No patient had a thromboembolic event.
  
  
  CONCLUSIONS
  In patients with uncomplicated cataract at high risk for thromboembolic events, phacoemulsification cataract surgery using a CCI under topical needle-free anesthesia was safely performed without discontinuing systemic anticoagulant and antiplatelet treatment.
authors.affiliation: Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, 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: Boris
authors.initials: B
authors.lastname: Shenkman
authors.forename: Ayelet
authors.initials: A
authors.lastname: Priel
authors.forename: Yael
authors.initials: Y
authors.lastname: Wasserzug
authors.forename: Ivan
authors.initials: I
authors.lastname: Budnik
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 / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005130:Eye Hemorrhage / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications; D011446:Prospective Studies; D011517:Prothrombin Time; D018570:Risk Assessment; D013923:Thromboembolism / Q000188:drug therapy; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin