Epidemiology of the association between anticoagulants and intraocular hemorrhage in patients with neovascular age-related macular degeneration.
OBJECTIVE
To determine the cumulative incidence and annual incidence of intraocular hemorrhage (subretinal hemorrhage or vitreous hemorrhage) in patients with neovascular age-related macular degeneration (AMD) and association with daily antiplatelet or anticoagulant (AP/AC) medication usage (aspirin, clopidogrel, and warfarin), age, gender, hypertension, diabetes mellitus, or bilateral neovascular AMD.


METHODS
Retrospective cross-sectional study in a tertiary university setting. Data on 195 eyes of 195 patients without previous intraocular hemorrhage examined over 73 months were reviewed.


RESULTS
Ninety-six of 195 patients (49.2%) were taking daily AP/ACs. Of patients taking daily AP/AC agents, 63.5% had hemorrhage compared with 29.2% of patients not taking (odds ratio = 4.21; 95% confidence interval = 1.42-8.46; P < 0.001). The overall annual incidence of intraocular hemorrhage was 0.14% per year. Among patients taking daily AP/AC, the cumulative incidence (61 of 96, 63.5%) and annual incidence (0.10%) of concurrent intraocular hemorrhage were significantly greater compared with patients not taking them (29 of 99, 29.2% and 0.04%, respectively; P < 0.0001). Fourteen of 18 patients (77%) taking more than 1 daily AP/AC had occurrence of intraocular hemorrhage. Antiplatelet or anticoagulant usage was an independent risk factor for the development of intraocular hemorrhage. The use of any agent resulted in a significantly increased risk of developing intraocular hemorrhage. Additionally, presence of bilateral neovascular AMD was a significant association in those taking daily AP/ACs, whereas age was a significant association in those not taking daily AP/AC agents.


CONCLUSIONS
All three daily AP/AC types were significantly associated with an increased risk of the development intraocular hemorrhage in patients with neovascular AMD, whereas gender, hypertension, and diabetes were not. Age was not significantly associated with hemorrhage in patients taking daily AP/AC agents, whereas the presence of bilateral neovascular AMD was significantly associated with hemorrhage. These findings indicate that the AP/AC use may predispose patients with neovascular AMD to intraocular hemorrhage more so than age and duration of disease alone. While the risk that discontinuing these medicines would pose to the patients' health may be too great to justify, ensuring that an appropriate medication dosage is maintained should be a priority within this patient population.
Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.
Daniel F
DF
Kiernan
Seenu M
SM
Hariprasad
Irene M
IM
Rusu
Sahil V
SV
Mehta
William F
WF
Mieler
Rama D
RD
Jager
D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D020256:Choroidal Neovascularization / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D008268:Macular Degeneration / Q000453:epidemiology*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012166:Retinal Hemorrhage / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D014823:Vitreous Hemorrhage / Q000453:epidemiology*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors