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In high-risk AMD patients, challenge use of anticoagulants
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KOLOA, Hawaii — While there is no consensus on whether or not blood thinning agents increase risk for significant submacular hemorrhage, Allen C. Ho, MD, believes they do.
At Retina 2017, Ho said, “In my perusal of the literature, I would say, yes, possibly for large hemorrhages.”
Allen C. Ho
Anti-platelet agents, such as aspirin and clopidogrel, tend to be safer for patients with AMD, Ho said, whereas coumadin (Warfarin, Bristol-Myers Squibb) and other anticoagulants, such as dabigatran (Pradaxa, Boehringer-Ingelheim), rivaroxaban (Xarelto, Janssen Pharmaceuticals) and apixaban (Eliquis, Bristol-Myers Squibb), all inhibit thrombin or prothrombin to thrombin, and tend to be less safe for AMD patients.
“The oral anticoagulants, in my mind, do not increase the incidence of hemorrhage, but if you’re going to develop hemorrhage, you’re more likely to develop a large hemorrhage,” he said.
Citing a case control study by Tilaeus et al. that compared 50 cases of massive submacular hemorrhage with 50 cases of limited submacular hemorrhage, Ho said in his presentation that the researchers found an 11.5 times greater likelihood for massive hemorrhage in patients taking coumadin, an anticoagulant, than in patients taking aspirin, an anti-platelet agent.
“We as retina specialists feel out of place telling patients to stop their oral anticoagulants because we know they are on it for cardiovascular risk prevention, but I think it’s reasonable to challenge use of oral anticoagulants in our high-risk patients,” Ho said. – by Patricia Nale, ELS
Reference:
Ho AC. Management of hemorrhagic AMD: Severity, risk factors and management. Presented at: Retina 2017; Jan. 16-20, 2017; Koloa, Hawaii.
Disclosure: Ho reports he is a consultant for Alcon.