Oral Anticoagulation and the Risk of Vitreous Hemorrhage and Retinal Tears in Eyes With Acute Posterior Vitreous Detachment

Witmer, Matthew T.; Cohen, Steven M.

doi:10.1097/iae.0b013e3182671006

Cited by 13 publications

(12 citation statements)

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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: 63%

“…Witmer and Cohen7 reported that patients taking aspirin, clopidogrel, or warfarin who developed acute posterior vitreous detachment were more likely to present with VH. Their results showed that the number of eyes with VH was significantly larger in patients taking antithrombotic medications than in those not taking them (43% vs. 31%, p =0.034).…”

Section: Discussionmentioning

confidence: 99%

“…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: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…There is limited information about the risks of anticoagulation in vitrectomy and less so in diabetic vitrectomy. [ 22 23 24 ] Although anticoagulant or antiplatelet therapy has not been thought to represent a risk factor for VH, it is prudent to consult with the physician before stopping treatment, as stopping either one could increase the risk of morbidity or mortality in these patients.…”

Section: Discussionmentioning

confidence: 99%

Vitreous rebleed following sutureless vitrectomy: Incidence and risk factors

Mahalingam¹,

Topiwalla²,

Ganesan³

2018

Indian J Ophthalmol

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Purpose:This study aims to evaluate the incidence and risk factors for vitreous rebleed (VRB) following 25-gauge sutureless vitrectomy for vitreous hemorrhage (VH) in diabetic retinopathy.Methods:A retrospective review of 190 diabetic patients having undergone vitrectomy for VH at a tertiary eye care center was analyzed. Demographic data of patients along with risk factors such as blood sugar levels (BSL), blood pressure (BP), anticoagulant use, and pan-retinal photocoagulation status (PRP) were tabulated. Depending on the commencement of VRB, patients were divided into immediate rebleed-within 2 weeks and delayed rebleed-beyond 2–4 weeks.Results:Forty-one patients had VRB, out of which 18 patients had immediate VRB and 23 patients had delayed VRB. The average duration between vitrectomy and VRB was 3.28 months. Twenty-eight patients were male and 13 were females. Average age at presentation was 53.8 years. Thirty-four patients (82.9%) were found to have high BSL and 28 patients (68.3%) had high BP and they developed rebleed (P < 0.01) after an initial hemorrhage-free period (average = 5.15 months). Fifteen patients (36.6%) underwent first time PRP intraoperatively, and they had immediate rebleed (P < 0.01) without any hemorrhage-free period (average = 0.9 months). Eight patients (19.5%) were on perioperative anticoagulants; however, their statistical significance did not persist in the multivariable model. There were neither age nor gender predilection toward rebleed (P > 0.05).Conclusion:The incidence rate of VRB was found to be 21.6%. Age and gender did not contribute to rebleed. Intraoperative PRP was a risk factor for immediate rebleed. Poor glycemic and BP control was a risk factor for delayed rebleed.

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Association of Rivaroxaban Anticoagulation and Spontaneous Vitreous Hemorrhage

Jun

Hwang

2015

JAMA Ophthalmol

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ral anticoagulation medications, such as aspirin, clopidogrel bisulfate, and warfarin sodium, have been associated with the development of vitreous hemorrhage. 1,2 While many cases of vitreous hemorrhage may resolve spontaneously, nonclearing vitreous hemorrhage may result in significant visual morbidity and require surgical intervention.Rivaroxaban is an oral anticoagulant increasingly used in the management of atrial fibrillation. It is an oral factor Xa inhibitor administered in a single daily dose. The use of rivaroxaban has been associated with hemorrhagic complications 3,4 involving the gastrointestinal, intracranial, and urinary systems. Other factor Xa inhibitors include fondaparinux, apixaban, and edoxaban.We demonstrate an association between rivaroxaban use and spontaneous vitreous hemorrhage. The risk may be particularly serious during the transition period, when more than 1 anticoagulant could be prescribed. Report of Cases Case 1A man in his mid-70s with a medical history of atrial fibrillation was evaluated for an acute vitreous hemorrhage of his right eye. The patient was in the process of transitioning his atrial fibrillation anticoagulation regimen from warfarin to rivaroxaban. His international normalized ratio was therapeutic. His ocular history was remarkable for a retinal

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Oral Anticoagulation and the Risk of Vitreous Hemorrhage and Retinal Tears in Eyes With Acute Posterior Vitreous Detachment

Cited by 13 publications

References 19 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

Vitreous rebleed following sutureless vitrectomy: Incidence and risk factors

Association of Rivaroxaban Anticoagulation and Spontaneous Vitreous Hemorrhage

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