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Antiplatelet, anticoagulant use linked to increased risk of intraocular hemorrhage in AMD patients
Retina. 2010;30(1):1573-1578.
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Antiplatelet and anticoagulant medication use correlated strongly with an elevated risk of intraocular hemorrhage in patients with neovascular age-related macular degeneration.
“While the risk that discontinuing these medicines would pose to the patients’ health may be too great to justify, ensuring that an appropriate medication dosage is maintained should be a priority within this patient population,” the study authors said.
The retrospective study included 195 eyes of 195 patients with no history of previous intraocular hemorrhage. Patients were followed over a 73-month interval.
Data showed that 96 patients (49.2%) were using daily antiplatelet or anticoagulant agents such as aspirin, clopidogrel or warfarin.
A significantly larger number of diabetic patients used daily antiplatelets or anticoagulants than non-diabetic patients.
Results showed that 91 patients (46.6%) had an intraocular hemorrhage during the study interval; the overall annual incidence of intraocular hemorrhage was 0.14%.
Patients using antiplatelets or anticoagulants daily had a 63.5% cumulative incidence and a 0.1% annual incidence of concurrent intraocular hemorrhage. Patients who did not use daily anticoagulants had a 29.2% cumulative incidence and 0.04% annual incidence of hemorrhage. The between-group difference was statistically significant (P < .0001).
Age, gender, hypertension and diabetes were not strongly associated with increased risk of intraocular hemorrhage.
This study demonstrated a statistically significant association between anticoagulants and intraocular hemorrhaging in patients with neovascular AMD. What we don’t know is whether or not there is any benefit to discontinuing these medicines in patients being treated for neovascular AMD, especially if the AMD is under good control. As the authors mention in the article, patients are often on such medicines for important systemic reasons and discontinuing their use may put the patients at a higher risk for a serious adverse cardiovascular event. Until we know more, at this time it may be best to monitor the patient closely and consider temporarily stopping antiplatelet or anticoagulant agents only if there is a relatively large hemorrhage, especially if the patient’s fellow eye does not see well. This recommendation, however, should only be made after consulting with the prescribing physician and, together, carefully weighing all risks, both ocular and systemic.
– Carl D. Regillo, MD
OSN Retina/Vitreous
Editorial Board member