warfarin and Conjunctival-Diseases

The aim of this study was to identify patients with subconjunctival hemorrhage (SCH) on warfarin therapy, to describe risk factors that may contribute to SCH development, and to identify complications related to SCH.. A retrospective chart review was conducted including patients treated at a university anticoagulation clinic over 2 years (4,334 patient visits). Data collection included patient demographics; international normalized ratios (INRs) before, at time of, and after SCH; risk factors for increased risk of bleeding; patient-reported complications related to SCH; recent changes in medication use; and warfarin dosage adjustments made in response to the event. The data were summarized using descriptive statistics and frequencies described as percentages.. Fifteen SCH events were identified at an event rate of 0.35%. Two were excluded because of related surgeries near the time of SCH events. The average patient age was 67.3 years (range, 51 to 82). A total of 76.9% (n = 10) of patients had INRs within the goal range at the appointment before reporting the SCH. A total of 46.2% (n = 6) of patients reported alterations in medication regimens during the month preceding SCH. Various patient conditions were documented that may increase the risk of SCH development. No ophthalmic complications were associated with SCHs.. An SCH event rate of 0.35% was identified. Many factors may have precipitated SCH; however, ophthalmic complications were uncommon.

Topics: Aged; Aged, 80 and over; Anticoagulants; Conjunctival Diseases; Eye Hemorrhage; Humans; Middle Aged; Retrospective Studies; Risk Factors; Warfarin

Patients who are on warfarin therapy may present with a variety of ocular side effects, particularly hemorrhages. These ocular events may be the only indication that the patient is at risk for serious sequelae, including hemorrhagic stoke.. A 76-year-old patient, taking warfarin, presented with a subconjunctival hemorrhage. Four days later the hemorrhage worsened, and the patient developed a headache. Blood testing revealed an elevated International Normalization Ratio (INR) and prothrombin time (PT). The patient's primary care physician adjusted the patient's medication dosage, and the patient's signs and symptoms improved.. Patients on warfarin therapy who present with ocular bleeding require immediate blood work and consultation with their primary care provider or cardiologist. The optometrist should be aware of the ocular and systemic sequelae of warfarin, its possible drug interactions, and potential controversies regarding cataract surgery in these patients.

Topics: Aged; Anticoagulants; Conjunctival Diseases; Diagnosis, Differential; Eye Hemorrhage; Female; Follow-Up Studies; Humans; Severity of Illness Index; Warfarin

A 65-year-old man on warfarin therapy with a sudden spontaneous onset of sub-conjunctival haematoma associated with bloody tears was assessed in the clinic following a referral from an optometrist. Due to discomfort, diplopia and lagophthalmos, the haematoma necessitated suspension of warfarin therapy and a surgical evacuation. The sub-conjunctival haematoma in a patient receiving warfarin can pose a significant management challenge.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Conjunctival Diseases; Eye Hemorrhage; Hematoma; Humans; Male; Warfarin

To review the frequency of hemorrhagic complications with sub-Tenon's anesthesia in patients on aspirin, warfarin or clopidogrel.. St. James's University Hospital, Leeds, United Kingdom.. Data were collected prospectively for patients having elective phacoemulsification under sub-Tenon's anesthesia. Seventy-five patients were on aspirin, 65 were on warfarin, and 40 were on clopidogrel. Seventy-five patients on no anticoagulants were used as the control group. No changes in the anticoagulant regimen were made prior to surgery.. No sight-threatening hemorrhagic complications were noted, and no surgery was postponed or cancelled due to an anesthesic complication. Subconjunctival hemorrhage occurred in 19% in the control group, 40% in the clopidogrel group, 35% in the warfarin group, and 21% in the aspirin group. The warfarin and clopidogrel groups had the highest incidence of subconjunctival hemorrhage (P<.05). The incidence of hemorrhages involving more than 1 quadrant was highest in these 3 groups; however, this did not achieve statistical significance (P = .37, Fisher exact test).. Data from this study support the continued use of anticoagulant agents among routine users during cataract surgery using a sub-Tenon's block.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia, Local; Anticoagulants; Aspirin; Cardiovascular Diseases; Cerebrovascular Disorders; Clopidogrel; Conjunctival Diseases; Connective Tissue; Eye Hemorrhage; Female; Humans; Lens Implantation, Intraocular; Male; Medical Audit; Middle Aged; Phacoemulsification; Prospective Studies; Risk Factors; Ticlopidine; Warfarin

To determine the incidence and nature of hemorrhagic complications in patients having phacoemulsification and foldable intraocular lens (IOL) implantation while taking aspirin or warfarin.. The Jules Stein Eye Institute, University of California at Los Angeles School of Medicine, Los Angeles, California, USA.. This retrospective study reviewed the charts from the practice of 1 ophthalmic surgeon. The type of medication, dosage, indication for anticoagulant therapy, type of incision, type of anesthesia, and intraoperative and postoperative hemorrhagic complications were recorded.. Sixty-two patients (82 eyes) taking aspirin and 25 patients (31 eyes) taking warfarin were identified. Seven eyes in the aspirin group (8.5%) and 3 in the warfarin group (9.7%) experienced subconjunctival hemorrhages. Eight of the 10 subconjunctival hemorrhages occurred in eyes with scleral incisions. The remaining 2 occurred in eyes with corneal incisions. No eye developed lid ecchymosis, retrobulbar hemorrhage, hyphema, or suprachoroidal hemorrhage.. Phacoemulsification with foldable IOL implantation was performed safely in patients taking aspirin or warfarin. Subconjunctival hemorrhage was the most common hemorrhagic complication.

Topics: Anticoagulants; Aspirin; Cardiovascular Diseases; Cerebrovascular Disorders; Conjunctival Diseases; Eye Hemorrhage; Humans; Lens Implantation, Intraocular; Phacoemulsification; Retrospective Studies; Warfarin

Recurrent, bilateral, and severe conjunctival hemorrhages mandate the search for an underlying etiology, such as a blood dyscrasia, blood clotting disorder, or recurrent increased intrathoracic pressure caused by repetitive vomiting or coughing spells. Medical and ophthalmic management is discussed in a case of subconjunctival and external hemorrhage from the eye secondary to prolonged prothrombin time in oral anticoagulation therapy.

Topics: Administration, Oral; Anticoagulants; Conjunctival Diseases; Fundus Oculi; Hemorrhage; Heparin; Humans; Hypertension; Male; Middle Aged; Ophthalmic Solutions; Prothrombin Time; Warfarin

To evaluate complications resulting from increased bleeding, 2,178 cataract surgery patients, 28 of whom were on anticoagulants, were studied prospectively. The anticoagulated patients showed no increase in sight-threatening complications when compared to the nonanticoagulated cataract patients.

Topics: Aged; Anticoagulants; Cataract Extraction; Conjunctival Diseases; Ecchymosis; Eyelid Diseases; Hemorrhage; Heparin; Humans; Hyphema; Middle Aged; Prospective Studies; Visual Acuity; Warfarin