Association of Rivaroxaban Anticoagulation and Spontaneous Vitreous Hemorrhage

Jun, Judy H.; Hwang, J.

doi:10.1001/jamaophthalmol.2015.2069

Cited by 16 publications

(6 citation statements)

References 7 publications

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“…Intraocular hemorrhages are a rare but potentially vision-threatening complication of systemic antithrombotic use. Previous studies have shown an increased risk for all types of intraocular hemorrhages in patients taking aspirin, clopidogrel, or warfarin, raising concerns over the safety of these medications …”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown an increased risk for all types of intraocular hemorrhages in patients taking aspirin, clopidogrel, or warfarin, raising concerns over the safety of these medications. [9][10][11][12][13][14][15][16] An analysis using the World Health Organization's database of adverse events suggests that the odds of having a retinal or vitreous hemorrhage while taking dabigatran or rivaroxaban far exceeds that of warfarin. 17 However, the results of this study are based strictly on voluntary physician report and do not quantify the number of patients using the medication.…”

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confidence: 99%

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Association of Novel Oral Antithrombotics With the Risk of Intraocular Bleeding

et al. 2018

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IMPORTANCE Novel oral anticoagulation and antiplatelet therapies have become a mainstay of treatment for thromboembolic disease. However, the safety profile of these medications has not been completely characterized. OBJECTIVE To determine the risk of developing intraocular hemorrhages with novel oral antithrombotic therapy compared with that of traditional antithrombotic agents. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, a large national insurance claims database was used to generate 2 parallel analyses. All patients with incident use of dabigatran etexilate or rivaroxaban between January 1, 2010, and September 30, 2015, were compared with patients with incident use of warfarin sodium. Similarly, patients with new use of prasugrel hydrochloride were compared with those with new use of clopidogrel bisulfate. Both analyses required the patient to be in the insurance plan for at least 24 months prior to initiation of therapy and excluded patients with any previous diagnosis of intraocular hemorrhages or any prescription for the comparator medications. Furthermore, the antiplatelet analysis required a diagnosis of acute coronary syndrome or a myocardial infarction within 60 days of initiation of pharmacologic therapy. The anticoagulant analysis excluded patients with end-stage renal disease, renal transplants, and those with heart valve disease.MAIN OUTCOMES AND MEASURES Incident intraocular hemorrhages at 90 and 365 days. Multivariate Cox proportional hazards regression models were used to compare the hazard ratio (HR) of developing an intraocular hemorrhage in individuals taking novel agents compared with those taking traditional medications. RESULTS A total of 146 137 patients taking warfarin (76 714 women and 69 423 men; mean [SD] age, 69.8 [11.8] years) were compared with 64 291 patients taking dabigatran or rivaroxaban (31 576 women and 32 715 men; mean [SD] age, 67.6 [11.7] years). Cox proportional hazards regression revealed a decreased hazard for developing an intraocular hemorrhage with dabigatran or rivaroxaban at 365 days (HR, 0.75; 95% CI, 0.58-0.97; P = .03), but not at 90 days (HR, 0.73; 95% CI, 0.22-2.63; P = .13). A total of 103 796 patients taking clopidogrel (37 578 women and 66 218 men; mean [SD] age, 68.0 [11.3] years) were compared with 8386 patients taking prasugrel (1988 women and 6380 men; mean [SD] age, 61.0 [9.6] years) and no increased hazard for developing an intraocular hemorrhage with prasugrel was seen at 90 days (HR, 0.75; 95% CI, 0.29-1.92; P = .55) or 365 days (HR, 1.19; 95% CI, 0.69-2.04; P = .53). CONCLUSIONS AND RELEVANCEThese results suggest a decreased risk of intraocular hemorrhage associated with novel direct thrombin inhibitors and direct factor Xa inhibitors, but no difference for P2Y 12 inhibitors compared with traditional vitamin K anticoagulation and antiplatelet therapy, respectively.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Association of Novel Oral Antithrombotics With the Risk of Intraocular Bleeding

et al. 2018

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“…[13][14][15] One welldescribed case report has linked rivaroxaban to spontaneous vitreous hemorrhage. 16 Despite epidemiologic studies demonstrating a link between oral anticoagulants and intraocular hemorrhage, to our knowledge, no study to date has examined and compared the risk of intraocular hemorrhage with warfarin and NOACs.…”

Section: Introductionmentioning

confidence: 99%

Risk of intraocular hemorrhage with new oral anticoagulants

Talany

Guo

Etminan

2016

Eye

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“…Jun et al reported three cases of spontaneous vitreous hemorrhage in patients taking rivaroxaban for atrial fibrillation. All three patients were transitioning from warfarin to rivaroxaban when they experienced a spontaneous vitreous hemorrhage [36]. Hemoperitoneum from atraumatic splenic rupture and in the setting of acute cholecystitis in patients taking DOACs has been reported [37,38].…”

Section: Epidemiologymentioning

confidence: 98%

A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants

Gunasekaran

Rajasurya²,

Devasahayam

et al. 2020

JCM

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Anticoagulation carries a tremendous therapeutic advantage in reducing morbidity and mortality with venous thromboembolism and atrial fibrillation. For over six decades, traditional anticoagulants like low molecular weight heparin and vitamin K antagonists like warfarin have been used to achieve therapeutic anticoagulation. In the past decade, multiple new direct oral anticoagulants have emerged and been approved for clinical use. Since their introduction, direct oral anticoagulants have changed the landscape of anticoagulants. With increasing indications and use in various patients, they have become the mainstay of treatment in venous thromboembolic diseases. The safety profile of direct oral anticoagulants is better or at least similar to warfarin, but several recent reports are focusing on spontaneous hemorrhages with direct oral anticoagulants. This narrative review aims to summarize the incidence of spontaneous hemorrhage in patients treated with direct oral anticoagulants and also offers practical management strategies for clinicians when patients receiving direct oral anticoagulants present with bleeding complications.

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Association of Rivaroxaban Anticoagulation and Spontaneous Vitreous Hemorrhage

Cited by 16 publications

References 7 publications

Association of Novel Oral Antithrombotics With the Risk of Intraocular Bleeding

Association of Novel Oral Antithrombotics With the Risk of Intraocular Bleeding

Risk of intraocular hemorrhage with new oral anticoagulants

A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants

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