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

Irina S. Barequet*, Tzukit Zehavi-Dorin, Nirit Bourla, Ilia Tamarin, Joseph Moisseiev, Ophira Salomon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)2671-2676
Number of pages6
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Issue number12
StatePublished - 1 Dec 2019


  • Anticoagulants
  • CHADSVASC score
  • Intraoperative bleeding
  • NOAC
  • Phacoemulsification


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