title: Ophthalmic Complications Associated with Direct Oral Anticoagulant Medications.
abstract: OBJECTIVE
  To describe the clinical features and management of six patients with ocular complications associated with direct oral anticoagulants (DOACs).
  
  
  METHODS
  The medical records of all adult patients known to be taking a DOAC and with an unusual bleeding event at a large tertiary referral center over a one-year period were reviewed. Patients with less than one-month follow-up were excluded. Data collection included relevant clinic notes, operative reports, surgical videos, and clinical images (fundus photography, optical coherence tomography, B-scan ultrasonography, and fluorescein angiography).
  
  
  RESULTS
  Six eyes in six patients were identified with an unusual bleeding event associated with DOAC use. One patient was taking apixaban, two patients were taking dabigatran, and three patients were taking rivaroxaban. Two patients had large submacular hemorrhage (including one with vitreous hemorrhage breakthrough), three patients had vitreous hemorrhage, and one patient had recurrent hyphema. Presenting visual acuity ranged from 20/40 to light perception. Three individuals required therapeutic and/or diagnostic pars plana vitrectomy for vitreous hemorrhage. Final visual acuity ranged from 20/25 to count finger vision. The associated DOAC was permanently discontinued in two of the six cases. Follow-up was one to four months from onset of identified DOAC-related complication.
  
  
  CONCLUSIONS
  DOAC use may be associated with ocular bleeding. Ophthalmologists should be aware of potential hemorrhagic complications and obtain consultation with primary providers regarding DOAC cessation guidelines.
authors.affiliation: a Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
authors.forename: Wen-Shi
authors.initials: WS
authors.lastname: Shieh
authors.affiliation: a Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
authors.forename: Jayanth
authors.initials: J
authors.lastname: Sridhar
authors.affiliation: a Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
authors.forename: Bryan K
authors.initials: BK
authors.lastname: Hong
authors.affiliation: a Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Maguire
authors.affiliation: a Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Rahimy
authors.affiliation: a Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
authors.forename: Abtin
authors.initials: A
authors.lastname: Shahlaee
authors.affiliation: a Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
authors.forename: Allen C
authors.initials: AC
authors.lastname: Ho
authors.affiliation: a Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Hsu
authors.affiliation: a Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
authors.forename: Carl D
authors.initials: CD
authors.lastname: Regillo
authors.affiliation: a Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Chiang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D000069604:Dabigatran / Q000009:adverse effects; D065427:Factor Xa Inhibitors / Q000009:adverse effects; D005260:Female; D006801:Humans; D006988:Hyphema / Q000139:chemically induced*; D008297:Male; D011720:Pyrazoles / Q000009:adverse effects; D011728:Pyridones / Q000009:adverse effects; D012166:Retinal Hemorrhage / Q000139:chemically induced*; D000069552:Rivaroxaban / Q000009:adverse effects; D014823:Vitreous Hemorrhage / Q000139:chemically induced*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Apixaban; dabigatran; hyphema; rivaroxaban; vitreous hemorrhage; warfarin