warfarin and Eye-Diseases

To conduct a systematic review of drug induced adverse ocular effects in diabetes to determine if this approach identified any previously unrecognised adverse drug effects; to make a preliminary assessment of the feasibility of this approach in identifying adverse drug reactions; and to assess the current accessibility of this information to prescribing physicians.. Literature search of online biomedical databases. The search strategy linked eye disorders with adverse drug reactions and diabetes. Source journals were classified as medical, pharmaceutical, diabetes related, or ophthalmological. It was determined whether the reactions identified were recorded in drug datasheets and the British National Formulary.. 63 references fulfilled the selection criteria, of which 45 were considered to be relevant to the study. The majority of these were case reports but cross sectional surveys, case-control and cohort studies, and review articles were also identified. 61% of the reactions were not recorded in the British National Formulary and 41% were not recorded in the datasheets. 55% appeared in specialist ophthalmology journals.. This is a feasible approach to the identification of adverse drug reactions. Adverse reactions not listed in the most commonly used reference sources were found. The majority were published in specialist ophthalmology journals which might not be seen by prescribing physicians.

Topics: Chlorpropamide; Contraceptives, Oral; Diabetes Mellitus; Eye Diseases; Glucocorticoids; Humans; Interferons; Online Systems; Streptokinase; Warfarin

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Allopurinol; Anti-Bacterial Agents; Antimalarials; Cardiac Glycosides; Cataract; Child; Chloroquine; Chlorpromazine; Epinephrine; Ethambutol; Ethchlorvynol; Eye Diseases; Female; Humans; Miotics; Nalidixic Acid; Phosphates; Pilocarpine; Quinolines; Retinal Degeneration; Warfarin

Cerebral venous sinus thrombosis (CVST) is uncommon. Risk factors include inherited and acquired factors. Rapid diagnosis and treatment is essential and can help prevent complications, which can include seizures and visual disturbance. A 25-year-old woman with a background history of CVST and intermittent warfarin use presented to the hospital in 2021 with a 3-month history of progressive eye swelling and headache. Her headache was located in the right frontal region and worsened with movement. Her workup was consistent with recurrent CVST and dural arteriovenous fistula. IR-guided embolization of the fistulas and stenting of her sinuses was performed. She was treated with dual antiplatelet therapy and therapeutic tinzaparin. Her symptoms improved markedly over several days, with improvement in headache and visual acuity. This case illustrates the potential for severe complications including visual disturbance in untreated CVST, as well as the importance of a thorough history and examination in aiding the recognition of the condition.

Topics: Adult; Central Nervous System Vascular Malformations; Clinical Reasoning; Cranial Sinuses; Eye Diseases; Female; Headache; Humans; Sinus Thrombosis, Intracranial; Warfarin

Patients with nonvalvular atrial fibrillation (NVAF) and type 2 diabetes are at risk of kidney, limb, and ophthalmic complications. We evaluated the rate of these complications and death in patients with NVAF and type 2 diabetes prescribed rivaroxaban or warfarin.. We analyzed Optum de-Identified electronic health record (EHR) data from 11/2010-12/2019. We included adults with NVAF and T2D newly initiated on rivaroxaban or warfarin with ≥12 months of prior EHR activity. Patients with another indication for anticoagulation, valve disease, history of end-stage renal disease, major adverse limb events (MALE), diabetic retinopathy or pregnancy were excluded. We evaluated the incidence rate of developing a composite outcome of >40% decrease in estimated glomerular filtration incidence rate (eGFR) from baseline, eGFR < 15 mL/minute/1.73 m2, need for dialysis or kidney transplant, MALE, diabetic retinopathy or death. Overlap weighting was used to balance baseline characteristics between cohorts while preserving sample size. Hazard ratios with 95% confidence intervals were calculated using propensity score-overlap weighted Cox regression.. We included 24,912 rivaroxaban and 58,270 warfarin users. The mean ± standard deviation (SD) CHA2DS2VASc score was 4.3 ± 1.5 and modified HASBLED score was 1.5 ± 0.8. Thirty percent of rivaroxaban patients were started on 15 mg once daily, with the rest prescribed 20 mg once daily. Warfarin patients had a mean time in therapeutic range of 47 ± 28%. Patients were followed for a mean of 2.89 ± 1.95 years. Rivaroxaban was associated with a reduced hazard of the composite outcome (HR = 0.93, 95%CI = 0.91-0.95; absolute risk reduction = 1.97 events per 1000 patient-years; number needed-to-treat = 51) versus warfarin. Rivaroxaban was also associated with significant reductions in the relative hazard of > 40% decrease in eGFR from baseline (HR = 0.96), need for dialysis or renal transplant (HR = 0.81), and limb revascularization or major amputation (HR = 0.85). Death occurred at a lower incidence rate with rivaroxaban (HR = 0.92, 95%CI = 0.89-0.95).. Rivaroxaban was associated with reduced incidence rates of kidney and limb complications, and death in NVAF patients with type 2 diabetes compared to warfarin.

Topics: Anticoagulants; Atrial Fibrillation; Dabigatran; Diabetes Mellitus, Type 2; Electronic Health Records; Eye Diseases; Humans; Kidney; Kidney Diseases; Retrospective Studies; Rivaroxaban; Stroke; Treatment Outcome; Warfarin

Topics: Aged; Anticoagulants; Dose-Response Relationship, Drug; Eye Diseases; Female; Humans; Hyphema; Pain; Treatment Outcome; Warfarin

To describe the clinical course of patients undergoing vitreoretinal procedures while receiving systemic anticoagulation with warfarin.. We reviewed patient demographics, ocular findings, and clinical courses for 25 patients receiving systemic anticoagulation with warfarin who subsequently underwent vitreoretinal surgery.. Patient ages ranged from 49 years to 81 years (median, 69 years). Indications for anticoagulation included atrial fibrillation, cerebrovascular disease, deep vein thrombosis, prosthetic heart valves, and hypercoagulable state. Follow-up ranged from 4 months to 36 months (median, 19.5 months). The international normalized ratio ranged from 1.5 to 3.1 (median, 2.0). Final vision after surgery ranged from 20/20 to 20/400 (median, 20/100). One patient who underwent scleral buckling and external drainage of subretinal fluid had an intraoperative subretinal hemorrhage associated with the drainage procedure. In all other patients, no intraoperative complications occurred.. Cessation of therapy with warfarin may not be necessary in patients receiving anticoagulation who are undergoing vitreoretinal procedures. Successful visual and anatomical results may be achieved after vitreoretinal surgery for patients receiving anticoagulation with warfarin. The management of anticoagulation should occur in conjunction with the patient's internist to allow a clear understanding of the potential systemic risks of cessation of warfarin treatment preoperatively.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Cerebrovascular Disorders; Cryotherapy; Eye Diseases; Female; Humans; International Normalized Ratio; Male; Middle Aged; Retinal Diseases; Retrospective Studies; Scleral Buckling; Thrombophilia; Venous Thrombosis; Vitrectomy; Vitreous Body; Warfarin

Topics: Diseases in Twins; Eye Diseases; Heterozygote; Homozygote; Humans; Infant, Newborn; Infant, Premature; Male; Ocular Physiological Phenomena; Protein C; Protein C Deficiency; Time Factors; Warfarin

The outcome of 50 surgical procedures in 41 patients who were anticoagulated at the time of surgery were reviewed to determine whether anticoagulation was associated with an increase in ophthalmic morbidity. Twenty-seven patients were receiving warfarin and 14 patients nicoumalone. The International Normalised Ratio (INR) was determined immediately prior to surgery and ranged from 1.1 to 4.9. Thirty-nine operations were performed under local anaesthetic and 11 under general anaesthetic. Thirty-three patients had extracapsular cataract extractions with posterior chamber lens implantation. No major haemorrhagic complications were associated with the local anaesthetic or the surgical procedure. Patients on anticoagulation therapy are at risk of life-threatening complications if their anticoagulation is stopped or reduced. This study demonstrates that most ophthalmic surgical procedures can be safely performed whilst the patient is therapeutically anticoagulated.

Topics: Acenocoumarol; Anticoagulants; Blood Loss, Surgical; Eye Diseases; Humans; Intraoperative Care; Prospective Studies; Thromboembolism; Warfarin

Spontaneous hyphaema in patients on systemic anticoagulants has been described in normal eyes and also in eyes with certain intraocular lenses following cataract surgery. These cases are rare and in all the reported cases the hyphaemas resolved without sequelae. Four cases are reported here of spontaneous hyphaemas in previously abnormal eyes of patients on anticoagulants. Three of these patients suffered considerable pain as a result of this. The reasons for this are discussed and early ophthalmic referral recommended if a hyphaema is suspected in these situations.

Topics: Adult; Aged; Eye; Eye Diseases; Female; Humans; Hyphema; Male; Middle Aged; Pain; Warfarin

An intraocular lens implant had to be removed 4 years after its implantation from the eye of a patient on warfarin (Coumadin) medication because of repeated intraocular haemorrhages. Implant cytology staining revealed a continuous membrane on the removed implant that contained relatively few large foreign body giant cells and great numbers of small fibroblast-like cells. An impressive clean-up function of the fibroblast-like cells with phagocytosis of whole erythrocytes was observed.

Topics: Aged; Eye; Eye Diseases; Female; Fibroblasts; Hemorrhage; Humans; Lenses, Intraocular; Phagocytosis; Warfarin

Topics: Adult; Aged; Aspirin; Dipyridamole; Eye Diseases; Female; Hemorrhage; Humans; Male; Middle Aged; Quinidine; Warfarin

Topics: Anticoagulants; Eye Diseases; Humans; Warfarin