title: Hemorrhagic complications after intravitreal injections of ranibizumab in patients under coumarin-type anticoagulation.
abstract: BACKGROUND
  It was the aim of this retrospective study to evaluate the risk of extra- or intraocular hemorrhages associated with intravitreal injections of ranibizumab in patients receiving anticoagulation therapy with coumarin derivatives.
  
  
  METHODS
  149 injections were performed in 50 patients who had preoperatively been instructed to continue their normal anticoagulation dose scheme. The coagulation status (Quick's time and/or INR) was checked the day before or on the day of injection. Clinical examinations including anterior and posterior segment biomicroscopy were performed in all patients within 24 hours before and 1 day, 1 week and 1 month after injection.
  
  
  RESULTS
  The average Quick value at the time of injection was 27 % +/- 15 % (median: 22 %, 95 % confidence interval: 24.6 - 29.3 %, range: 6 - 95 %), the average INR 2.32 +/- 0.79 (median: 2.2, 95 % confidence interval: 2.17 - 2.47 range:0.8 - 4.9). Minor subconjunctival hemorrhages were observed in 26 of 149 injections (17.4 %). New intraocular hemorrhages or other coagulation-related complications associated to the injection therapy were not observed.
  
  
  CONCLUSIONS
  Our study suggests that there is a low risk of coagulation-related complications in patients receiving intravitreal injections of ranibizumab even if the use of cumarin derivatives is continued within the normal therapeutic range.
authors.affiliation: Abteilung für Retinologie, Klinik Pallas, Olten, Switzerland.
authors.forename: V
authors.initials: V
authors.lastname: Loukopoulos
authors.forename: C
authors.initials: C
authors.lastname: Meier
authors.forename: H
authors.initials: H
authors.lastname: Gerding
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants / Q000009:adverse effects; D003374:Coumarins / Q000009:adverse effects*; D004338:Drug Combinations; D005130:Eye Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D012189:Retrospective Studies; D014822:Vitreous Body
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D003374:Coumarins; D004338:Drug Combinations; C030123:coumarin; D000069579:Ranibizumab