Association Between Systemic Anticoagulation and Rate of Intraocular Hemorrhage Following Intravitreal Anti-VEGF Therapy for Age-Related Macular Degeneration

Olson, Joanna; Kerchner, Denise; Kunselman, Allen R.

doi:10.3928/23258160-20130909-06

Cited by 14 publications

(7 citation statements)

References 24 publications

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“…However, the incidence of VH in AF patients with antithrombotic medications has not been well identified. While some studies have reported that antiplatelet or anticoagulation medication increases the possibility of intraocular hemorrhage,678 others had contrary findings 910111227. In this study, while the incidence of VH was 1.45 cases per 1000 person-years in warfarin monotherapy, it increased to 8.91 cases per 1000 person-years by triple therapy.…”

Section: Discussioncontrasting

confidence: 60%

“…Vitreous hemorrhage (VH) is a potential intraocular hemorrhagic complication associated with oral antiplatelet or anticoagulant medication, such as aspirin, clopidogrel bisulfate, and warfarin sodium 6789101112. Although VH can be absorbed spontaneously, it can also result in more serious complications threatening vision, such as intraocular pressure increase and proliferative vitreoretinopathy, leading to invasive surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

“…Previous clinical studies have reported varying degrees of associations between VH and oral antiplatelet or anticoagulant use 6789101112. However, most studies were performed on populations with specific retinal diseases or patients undergoing intraocular interventions.…”

Section: Introductionmentioning

confidence: 99%

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Antithrombotic Medication and the Risk of Vitreous Hemorrhage in Atrial Fibrillation: Korean National Health Insurance Service National Cohort

et al. 2019

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PurposeAntithrombotic therapy could be related with nuisance bleeding. This study investigated whether vitreous hemorrhage (VH) is associated with specific types of antithrombotic medication in patients with atrial fibrillation (AF).Materials and MethodsIn the Korean National Health Insurance Service National Sample Cohort, we identified 9352 antiplatelet/anticoagulant-treated AF patients. The occurrence of VH was compared between warfarin (n=1493) and a propensity score (PS)-matched antiplatelet group (n=1493) and between warfarin (n=1493) and a PS-matched warfarin+antiplatelet group (n=1493).ResultsThe outcomes of VH were lower in the warfarin than in the matched antiplatelet (1.45 vs. 3.72 events/1000 patient-years) and matched warfarin+antiplatelet groups (1.45 vs. 6.87 events/1000 patient-years). Compared with warfarin, the risk of VH increased with antiplatelet [adjusted hazard ratio (aHR) 3.90; 95% confidence interval (CI) 1.22–12.4, p=0.022] and warfarin+antiplatelet agents (aHR 4.39, 95% CI 1.74–11.2, p=0.002). Compared with warfarin only, warfarin+antiplatelet agents increased the risk of VH in patients ≥65 years, regardless of gender and hypertension. The risk of VH was significantly higher with dual antiplatelet therapy (aHR: 5.02, 95% CI: 1.56–16.2, p=0.007) or in dual (aHR: 5.02, 95% CI: 1.74–14.5, p=0.003) or triple therapy using warfarin and antiplatelet agents than with warfarin monotherapy (aHR: 6.12, 95% CI: 1.76–21.3, p=0.004).ConclusionDual antiplatelet or triple therapy increased the risk of VH significantly, compared to warfarin monotherapy. Considering the low efficacy of preventing ischemic stroke and high risk of bleeding, dual or triple therapy using warfarin and antiplatelet agents should be avoided to prevent VH in AF patients.

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Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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Antithrombotic Medication and the Risk of Vitreous Hemorrhage in Atrial Fibrillation: Korean National Health Insurance Service National Cohort

et al. 2019

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“…Several studies have shown that anticoagulation was not associated with an increased risk of hemorrhagic or any other complication following IVI [50-52]. …”

Section: Considerations Before Injectionmentioning

confidence: 99%

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

et al. 2018

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Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year. The article presents the most up-to-date review on IVI epidemiology and techniques. Unfortunately, important issues related to pre-, peri- and postinjection management lack randomized clinical trials for a final conclusion. Also, a great diversity of approaches exists worldwide. Therefore, expert consensus recommendations on IVI techniques are provided.

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“…O uso de ranibizumabe (RAZ) para tratamento de DMRI em pacientes mais idosos pode estar associado com aumento do risco de eventos hemorrágicos não oculares 31 . Não está indicada a suspensão de anti-coagulantes antes do procedimento, visto que a sua manutenção não foi associada com aumento no risco de eventos adversos hemorrágicos 32 .…”

Section: Doenças Sistêmicasunclassified

Protocolo de injeções intravítreas do Hospital de Clínicas de Porto Alegre: uma revisão de condutas para uma assistência mais qualificada

Falavigna¹,

Scheid²,

Lavinsky³

et al. 2021

CBR

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A injeção intravítrea é o procedimento oftalmológico mais realizado no mundo. Através dessa técnica é possível administrar medicamentos para o segmento posterior do olho, sendo a via de escolha para o tratamento da maioria das patologias coriorretinianas. O evento ocular adverso mais grave é a endoftalmite pós injeção. Diversas medidas foram sugeridas para diminuição do risco dessa complicação, com evidências variáveis. Tendo em vista o grande número de injeções realizado em nosso serviço de oftalmologia do Hospital de Clínicas de Porto Alegre (HCPA), realizamos uma revisão da literatura com o objetivo de definir as melhores práticas. Nós descrevemos a evidência disponível para os principais aspectos dos diferentes estágios do procedimento (pré injeção, peri injeção e pós injeção) e apresentamos nosso protocolo. A medida com maior evidência científica na profilaxia da endoftalmite é a aplicação de iodopovidona tópica pelo menos trinta segundos antes da injeção.

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Association Between Systemic Anticoagulation and Rate of Intraocular Hemorrhage Following Intravitreal Anti-VEGF Therapy for Age-Related Macular Degeneration

Abstract: The rate of intraocular hemorrhage after intravitreal injection of anti-VEGF therapy among patients with AMD is low, and there is no significant difference between patients taking systemic anticoagulant medications at the time of injection and patients not on anticoagulation.

Cited by 14 publications

References 24 publications

Antithrombotic Medication and the Risk of Vitreous Hemorrhage in Atrial Fibrillation: Korean National Health Insurance Service National Cohort

Antithrombotic Medication and the Risk of Vitreous Hemorrhage in Atrial Fibrillation: Korean National Health Insurance Service National Cohort

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

Protocolo de injeções intravítreas do Hospital de Clínicas de Porto Alegre: uma revisão de condutas para uma assistência mais qualificada

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