Retinal tears after posterior vitreous detachment and vitreous hemorrhage in patients on systemic anticoagulants

Abstract

Aims or Purpose To determine the rate of retinal tears (RTs) after posterior vitreous detachment (PVD) and vitreous hemorrhage (VH) in patients on systemic anticoagulants. Methods In all, 260 eyes of 260 patients with an acute PVD and VH were followed for evidence of an RT or detachment. Patients were divided into those taking systemic anticoagulants and those not taking anticoagulants. Results A total of 137 patients (53%) were taking anticoagulants, 123 (47%) were not. Overall, 72% of patients not taking any anticoagulant had evidence of an RT, whereas 46% of patients taking an anticoagulant had an RT (P-value 0.0002). Also, 37% of patients not taking an anticoagulant had a retinal detachment (RD), whereas 23% of patients taking any anticoagulant had an RD (P-value 0.01). Conclusions In patients with an acute PVD and VH using anticoagulants, RTs and RDs were common. Anticoagulation status may be an important contributing factor in predicting the incidence of an RT or detachment.

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

“…The authors of the recent report, however, did not present data of patients with acute PVD without VH. 23 Although we have demonstrated a trend toward a lower prevalence of tears in patients on systemic anticoagulation with acute PVD and VH, perhaps statistical significance was not reached in our study because of a smaller sample size.…”

“…A recent report has found a significantly lower prevalence of retinal tears and detachment in patients with acute PVD and VH taking systemic anticoagulation medication. 23 This is not surprising given the results from our study demonstrating an increased risk of VH in patients with acute PVD taking anticoagulant medication. The authors of the recent report, however, did not present data of patients with acute PVD without VH.…”

Antiplatelets and Anticoagulants in Vitreoretinal Surgery: A Systematic Review

“…El-Sanhouri et al [ 29 ], in 2011, aimed at determining the rate of retinal tears after posterior vitreous detachment (PVD) and vitreous hemorrhage in patients taking systemic anticoagulants. A total of 260 eyes with acute PVD and vitreous hemorrhages were included in the act of looking for any signs of retinal tear or detachment.…”

“…The same applies to the increased chance of vitreous hemorrhages in PVD and retinal tear presentation for patients on anticoagulants and antiplatelets, as shown by Witmer et al [ 23 ]. El-Sanhouri et al [ 29 ] expanded on that by showing anticoagulation to even be a protective factor; patients with vitreous hemorrhages and acute PVD taking anticoagulants were shown to have a lower risk of retinal tears. A plethora of further studies confirmed that it is safe continue, and possibly inappropriate to stop, taking anticoagulants and antiplatelets, especially in the face of an increased risk of systemic thromboembolic accidents [ 16 , 17 , 20 , 22 , 24 , 26 , 27 ].…”

Ocular Problems in the Patient with End‐Stage Renal Disease

“…A concern for these patients is whether systemic heparinization or the use of periodic tissue plasminogen activator therapy (to maintain dialysis catheter patency) increases the risk for retinal hemorrhage. While there are no specific studies that examine this issue, extrapolation from nondialysis populations receiving either aspirin or oral anticoagulation shows no increased risk of retinal hemorrhage in patients with underlying retinal disease (34–36). For example, in a study of 40,899 patients with a history of diabetic retinopathy who received thrombolytic therapy for acute myocardial infarction, 0.03% had ocular bleeding, suggesting that diabetic retinopathy should not be a contraindication to thrombolysis (37).…”