warfarin and Eye-Hemorrhage

It is unclear if the risk of intraocular bleeding with novel oral anticoagulants differs compared with warfarin.. To characterize the risk of intraocular bleeding with novel oral anticoagulants compared with warfarin.. A systematic review and meta-analysis was undertaken in an academic medical setting. MEDLINE and ClinicalTrials.gov were searched for randomized clinical trials published up until August 2016. This search was supplemented by manual bibliography searches of identified trials and other review articles.. Studies were eligible for inclusion if they were phase 3 randomized clinical trials, enrolled patients with atrial fibrillation or venous thromboembolism, compared a novel oral anticoagulant (dabigatran, rivaroxaban, apixaban, or edoxaban) with warfarin, and recorded event data on intraocular bleeding. Data on intraocular bleeding were pooled using inverse-variance, weighted, fixed-effects meta-analysis.. The PRISMA guidelines were used for abstracting data and assessing quality. Independent extraction was performed by 2 investigators.. Intraocular bleeding events and associated risk ratio for novel oral anticoagulants compared with warfarin.. Twelve trials investigating 102 627 patients were included. Randomization to novel oral anticoagulants was associated with a 22% relative reduction in intraocular bleeding compared with warfarin (risk ratio, 0.78; 95% CI, 0.61-0.99). There was no significant heterogeneity observed (I2 = 4.8%, P = .40). Comparably lower risks of intraocular bleeding with novel oral anticoagulants were seen in subgroup analyses, with no significant difference according to the indication for anticoagulation (P for heterogeneity = .49) or the novel oral anticoagulant type (P for heterogeneity = .15). Summary estimates did not differ materially when random-effects meta-analytic techniques were used.. These results suggest that novel oral anticoagulants reduce the risk of intraocular bleeding by approximately one-fifth compared with warfarin. Similar benefits were seen in both patients with atrial fibrillation and venous thromboembolism. Our data have particular relevance for patients at higher risk of spontaneous retinal and subretinal bleeding. These findings may also have important implications in the perioperative period, in which the use of novel oral anticoagulants may be superior. Future studies are required to better characterize the optimal management of patients with both ophthalmic disease and cardiovascular comorbidities requiring anticoagulation.

Topics: Administration, Oral; Anticoagulants; Atrial Fibrillation; Dabigatran; Eye Hemorrhage; Humans; Pyrazoles; Pyridines; Pyridones; Randomized Controlled Trials as Topic; Risk Assessment; Rivaroxaban; Thiazoles; Venous Thromboembolism; Warfarin

In patients who are receiving warfarin therapy and require cataract surgery, it may be possible to continue warfarin in the perioperative period but the safety of this management strategy has not been systematically evaluated.. We performed a systematic review of the literature to assess the safety (bleeding events) of continuing warfarin before and after cataract surgery. We included studies that enrolled patients undergoing cataract surgery who were anticoagulated with warfarin alone and that reported bleeding events as an outcome. Study quality was assessed using a validated form. Odds ratios and bleeding rates were pooled to give summary estimates of bleeding risk.. We identified 11 studies (5 cohort and 6 case series) assessing bleeding risk associated with warfarin continuation during cataract surgery. Patients who continued warfarin had an increased risk for bleeding (odds ratio; 3.26; 95% confidence interval [CI]: 1.73-6.16). The overall incidence of bleeding (95% CI) was 10% (5-19). Almost all bleeding events were self-limiting and not significant, consisting of dot hyphemae or subconjunctival hemorrhages. No patient had compromised visual acuity related to a bleeding event.. Patients who are receiving warfarin therapy and undergo cataract surgery without warfarin interruption have an increased risk for bleeding but such bleeds are not clinically significant. The low quality of studies assessed, however, precludes definitive conclusions as to the risk for bleeding in patients who continue warfarin around the time of cataract surgery.

Topics: Cataract Extraction; Eye Hemorrhage; Humans; Incidence; Risk Assessment; Risk Factors; Treatment Outcome; Warfarin

Topics: Anticoagulants; Eye Hemorrhage; Humans; Ophthalmologic Surgical Procedures; Surgery, Plastic; Warfarin

Topics: Anticoagulants; Aspirin; Blood Coagulation; Cataract Extraction; Contraindications; Dipyridamole; Eye Hemorrhage; Humans; Platelet Aggregation; Thrombosis; Warfarin

To estimate the risks and benefits associated with continuation of anticoagulants or antiplatelet medication use before cataract surgery.. Prospective cohort study.. Patients 50 and older scheduled for 19,283 cataract surgeries at nine centers in the United States and Canada between June 1995 and June 1997.. None.. Intraoperative and postoperative (within 7 days) retrobulbar hemorrhage, vitreous or choroidal hemorrhage, hyphema, transient ischemic attack (TIA), stroke, deep vein thrombosis, myocardial ischemia, and myocardial infarction.. Before cataract surgery 24.2% and 4.0% of patients routinely used aspirin and warfarin, respectively. Among routine users, 22.5% of aspirin users and 28.3% of warfarin users discontinued these medications before surgery. The rates of stroke, TIA, or deep vein thrombosis were 1.5/1000 among those who did not use aspirin or warfarin and 3.8/1000 surgeries among routine users of aspirin and warfarin who continued their medication before surgery. The rate was 1 event per 1000 surgeries among those who discontinued aspirin use (relative risk = 0.7, 95% confidence interval = 0.1-5.9). There were no events among warfarin users who discontinued use. The rates of myocardial infarction or ischemia were 5.1/1000 surgeries (aspirin) and 7.6/1000 surgeries (warfarin) among routine continuous users and no different from those of routine users who discontinued use.. The risks of medical and ophthalmic events surrounding cataract surgery were so low that absolute differences in risk associated with changes in routine anticoagulant or antiplatelet use were minimal.

Topics: Aged; Anticoagulants; Aspirin; Canada; Cataract Extraction; Eye Hemorrhage; Female; Humans; Male; Middle Aged; Myocardial Ischemia; Platelet Aggregation Inhibitors; Prospective Studies; Risk Assessment; Thromboembolism; United States; Warfarin

Patients undergoing intraocular surgery are elderly and may have disease or be receiving medication which increases the risk of haemorrhage. We interviewed 1383 consecutive patients scheduled for eye surgery requiring retrobulbar/peribulbar block about their use of non-steroidal anti-inflammatory drugs, oral steroids and warfarin. A history of diabetes mellitus and globe axial length was noted. Medial peribulbar and inferolateral retrobulbar blocks were performed by three specialists and six doctors in training. The ensuing haemorrhages were graded as follows: 1 = spot ecchymosis; 2 = lid ecchymosis involving half of the lid surface area or less; 3 = lid ecchymosis all around the eye, no increase in intraocular pressure; 4 = retrobulbar haemorrhage with increased intraocular pressure. Acetylsalicylic acid was taken by 482 (35%) patients, non-steroidal anti-inflammatory drugs by 260 (19%) and warfarin by 76 (5.5%). Lid haemorrhages (grades 1-3) were observed in 55 patients (4.0%); in 33 of these patients the haemorrhages were spotlike (grade 1). No grade 4 haemorrhages occurred. The preoperative use of acetylsalicylic acid, non-steroidal anti-inflammatory drugs or warfarin, whether or not they had been discontinued, did not predispose to haemorrhage associated with retrobulbar/peribulbar block.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia, Local; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Aspirin; Eye Hemorrhage; Eyelid Diseases; Female; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Prospective Studies; Retrobulbar Hemorrhage; Risk Factors; Warfarin

We investigated the prevalence of retinal vascular occlusion and intraocular bleeding and compare their risks in patients undergoing anticoagulant therapy, either with non-vitamin K-antagonist oral anticoagulants (NOAC) or warfarin. We performed a cohort study (January 2015 to April 2018) in 281,970 patients with nonvalvular atrial fibrillation (AF) using health claims in the nationwide database of the Health Insurance Review and Assessment service of Korea. A Cox-proportional hazard regression was used to calculate the hazard ratio (HR) for retinal vascular occlusion or intraocular bleeding. The HR of retinal vascular occlusion was estimated to 1.59 (95% confidence interval [CI], 1.35-1.86) for NOAC users compared to that with warfarin users. Among the various types of NOACs, all NOACs showed higher risk of retinal vascular occlusion than did warfarin. For intraocular bleeding, the HR was estimated to be 0.86 (95% CI, 0.75-0.98) for NOAC users compared with that with warfarin users. The risk of retinal vascular occlusion was higher in NOAC users than in warfarin users, while the risk of intraocular bleeding was lower with NOAC therapy. NOACs were not found to be as effective as warfarin for retinal vascular occlusion, but safe in terms of intraocular bleeding.

Topics: Administration, Oral; Aged; Anticoagulants; Atrial Fibrillation; Cohort Studies; Eye Hemorrhage; Female; Humans; Insurance Claim Review; Male; Prevalence; Republic of Korea; Retinal Vein Occlusion; Warfarin

Novel oral anticoagulation and antiplatelet therapies have become a mainstay of treatment for thromboembolic disease. However, the safety profile of these medications has not been completely characterized.. To determine the risk of developing intraocular hemorrhages with novel oral antithrombotic therapy compared with that of traditional antithrombotic agents.. In this retrospective cohort study, a large national insurance claims database was used to generate 2 parallel analyses. All patients with incident use of dabigatran etexilate or rivaroxaban between January 1, 2010, and September 30, 2015, were compared with patients with incident use of warfarin sodium. Similarly, patients with new use of prasugrel hydrochloride were compared with those with new use of clopidogrel bisulfate. Both analyses required the patient to be in the insurance plan for at least 24 months prior to initiation of therapy and excluded patients with any previous diagnosis of intraocular hemorrhages or any prescription for the comparator medications. Furthermore, the antiplatelet analysis required a diagnosis of acute coronary syndrome or a myocardial infarction within 60 days of initiation of pharmacologic therapy. The anticoagulant analysis excluded patients with end-stage renal disease, renal transplants, and those with heart valve disease.. Incident intraocular hemorrhages at 90 and 365 days. Multivariate Cox proportional hazards regression models were used to compare the hazard ratio (HR) of developing an intraocular hemorrhage in individuals taking novel agents compared with those taking traditional medications.. A total of 146 137 patients taking warfarin (76 714 women and 69 423 men; mean [SD] age, 69.8 [11.8] years) were compared with 64 291 patients taking dabigatran or rivaroxaban (31 576 women and 32 715 men; mean [SD] age, 67.6 [11.7] years). Cox proportional hazards regression revealed a decreased hazard for developing an intraocular hemorrhage with dabigatran or rivaroxaban at 365 days (HR, 0.75; 95% CI, 0.58-0.97; P = .03), but not at 90 days (HR, 0.73; 95% CI, 0.22-2.63; P = .13). A total of 103 796 patients taking clopidogrel (37 578 women and 66 218 men; mean [SD] age, 68.0 [11.3] years) were compared with 8386 patients taking prasugrel (1988 women and 6380 men; mean [SD] age, 61.0 [9.6] years) and no increased hazard for developing an intraocular hemorrhage with prasugrel was seen at 90 days (HR, 0.75; 95% CI, 0.29-1.92; P = .55) or 365 days (HR, 1.19; 95% CI, 0.69-2.04; P = .53).. These results suggest a decreased risk of intraocular hemorrhage associated with novel direct thrombin inhibitors and direct factor Xa inhibitors, but no difference for P2Y12 inhibitors compared with traditional vitamin K anticoagulation and antiplatelet therapy, respectively.

Topics: Administration, Oral; Aged; Anticoagulants; Antithrombins; Dabigatran; Dose-Response Relationship, Drug; Eye Hemorrhage; Factor Xa Inhibitors; Female; Follow-Up Studies; Humans; Incidence; Male; Pennsylvania; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Rivaroxaban; Thromboembolism; Warfarin

Topics: Anticoagulants; Dabigatran; Eye Hemorrhage; Humans; Warfarin

PurposeTo assess the risk of intraocular hemorrhage with warfarin and new oral anticoagulants (NOACs).MethodsWe ascertained all reported cases of intraocular hemorrhage (vitreous, choroidal, or retinal) with warfarin and NOACs (including dabigatran, rivaroxaban, apixaban) from the World Health Organizations's Vigibase database from 1968-2015. We used a disproportionality analysis to compute reported odds ratios (RORs) and corresponding 95% confidence by comparing the number of events with the study outcomes and study drugs compared with all other drugs reported to Vigibase. A harmful signal was deemed for a lower limit of the 95% confidence interval above 1.ResultsWe identified 80 cases of intraocular hemorrhage (vitreous, choroidal, or retinal) with warfarin in the World Health Organizations's Vigibase database from 1968-2015. A total of 156 cases of intraocular hemorrhage with NOACs (82 with rivaroxaban, 65 with dabigatran, 9 with apixaban). Warfarin had the highest signal of association with choroidal hemorrhage (ROR= 65.40 (33.86-126.30)). Rivaroxaban had the highest signal of association with both retinal and vitreous hemorrhage (ROR=7.41 (5.73-9.59) and ROR= 11.14 (7.37-16.86), respectively). Dabigatran was also significantly associated with retinal and vitreous hemorrhage (ROR= 3.78 (2.82-5.08) and ROR= 5.83 (3.66-9.30), respectively). The number of reports of retinal and vitreous hemorrhage were also significantly higher with apixaban, but the number of cases may be too little to make a meaningful evaluation.ConclusionA signal for risk of intraocular hemorrhage was detected for warfarin, dabigatran, and rivaroxaban. Large epidemiologic studies are needed to further confirm these findings.

Topics: Anticoagulants; Dabigatran; Eye Hemorrhage; Humans; Ocular Hypertension; Odds Ratio; Pyrazoles; Pyridones; Risk Factors; Rivaroxaban; Stroke; Warfarin

Topics: Administration, Oral; Anticoagulants; Antithrombins; Blood Loss, Surgical; Cataract Extraction; Dabigatran; Eye Hemorrhage; Factor Xa Inhibitors; Humans; Pyrazoles; Pyridones; Rivaroxaban; Warfarin

Iris vascular tufts are rare iris stromal vascular hamartomas. Patients with iris vascular tufts generally remain asymptomatic until presenting with a spontaneous hyphaema or with mild intraoperative pupil margin haemorrhage during anterior segment surgery. This is the first reported case of spontaneous hyphaema from iris vascular tuft related to a documented supratherapeutic International Normalised Ratio as a predisposing factor. At 86 years of age, this patient also represents the oldest documented first occurrence of bleeding from an iris vascular tuft.. An 86 year old Caucasian lady presented with sudden and persisting loss of vision in her right eye, ocular pain and vomiting. She had a supratherapeutic International Normalised Ratio of 3.9 related to Warfarin use. Her intraocular pressure in the right eye was raised at 55 mmHg, with a 1.6 mm hyphaema and multiple iris vascular tufts visible around the entire pupil.. The present case highlights the risk of anticoagulation therapy as a predisposing factor for spontaneous hyphaema and adds to the management considerations for this condition. It also demonstrates the need for Ophthalmologists to be aware of iris vascular tufts as a cause for spontaneous hyphaema, independent of age and systemic associations.

Topics: Aged, 80 and over; Anticoagulants; Antihypertensive Agents; Atropine; Eye Hemorrhage; Female; Glucocorticoids; Hamartoma; Humans; Hyphema; International Normalized Ratio; Iris Diseases; Mydriatics; Ophthalmic Solutions; Prednisolone; Pulmonary Embolism; Warfarin

To establish the prevalence of anticoagulation (vitamin K antagonists) and antiplatelet agent therapy in patients undergoing vitreoretinal surgery and to compare the outcome of peribulbar anesthesia and vitreoretinal surgery between users and nonusers.. We conducted a retrospective case series study in one academic center. No changes in the treatment regimen were made before surgery. Patients were divided into 3 groups: G1, patients with no anticoagulant or antiplatelet therapy; G2, patients treated with anticoagulants; and G3, patients treated with aspirin, clopidogrel, or both.. Two hundred and six eyes (206 patients) were included. G1, 144 eyes (69.9%) without any anticoagulant or antiplatelet therapy (69.9%); G2, 12 eyes (5.8%) with anticoagulants; and G3, 44 eyes (21.4%) with antiplatelet agents. Six patients (6 eyes) (2.9%) received both anticoagulant and antiplatelet agents. The incidence of overall and mild postoperative hemorrhagic complications was similar between groups, P = 0.075 and P = 0.127, respectively. However, potential sight-threatening hemorrhagic complications were more frequent in patients receiving antiplatelet agents, P < 0.003.. Peribulbar anesthesia for vitreoretinal surgery can probably be performed safely in patients receiving anticoagulants. However, retinal surgeons should be aware that severe bleeding complications are more frequent in patients receiving antiplatelet therapy.

Topics: Acenocoumarol; Adult; Aged; Aged, 80 and over; Anesthesia, Local; Anticoagulants; Aspirin; Clopidogrel; Conscious Sedation; Electrocardiography; Eye Hemorrhage; Female; Humans; Male; Middle Aged; Orbit; Oximetry; Phenindione; Platelet Aggregation Inhibitors; Postoperative Hemorrhage; Retrospective Studies; Ticlopidine; Vitreoretinal Surgery; Warfarin; Young Adult

To evaluate changes in the prevalence of antiplatelet (aspirin, clopidogrel) and anticoagulation (warfarin) therapy and its possible relationship to postoperative bleeding in vitreoretinal surgery (VRS) patients.. Observational, retrospective case control study.. setting: University practice.study population: A total of 822 patents who underwent VRS during 3 intervals in 1994, 2004, and 2008.observation procedure: Retrospective chart review for 1994 and 2004, but contemporaneous in 2008.main outcome measures: Proportion using antiplatelets or anticoagulants, the incidence of early postoperative intraocular bleeding in patients, and clinical consequence of the hemorrhage.. Thirty-one of 213 patients (14.6%) who underwent VRS in 1994, 103 of 361 patients (28.5%) in 2004, and 80 of 248 patients (32.3%) in 2008 had taken antiplatelet therapy (P < .001). The rates of anticoagulant therapy did not vary. The incidence of bleeding was higher (20.0%) in the patients who did not suspend antiplatelets than in those who did (9.6%) (P = .05, χ(2) test), but this difference lost statistical significance in a multivariate analysis (P = .079). Anticoagulant was associated with intraocular hemorrhage at postoperative first day after vitrectomy (P = .03, Fisher exact test). No reoperation or failure of the surgery was attributable to the hemorrhage in anticoagulant or antiplatelet patients.. Use of antiplatelet agents has increased in patients undergoing vitreoretinal surgery but probably does not increase the risk of postoperative intraocular bleeding; however, when safe to suspend even for a short time the potential risk is further reduced. Anticoagulant use was associated with a higher risk, but without serious consequences. Working with a patient's medical doctor may allow safe suspension in some cases, which may further lower these risks.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Case-Control Studies; Child; Clopidogrel; Contraindications; Eye Hemorrhage; Female; Humans; Incidence; Male; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Hemorrhage; Retrospective Studies; Risk Factors; Ticlopidine; Vitreoretinal Surgery; Warfarin

To assess the safety of phacoemulsification cataract extraction in patients on combined anticoagulant and antiplatelet treatment.. Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.. Prospective interventional case series.. Consecutive patients with simple cataract on combined anticoagulant (warfarin) and antiplatelet (aspirin or clopidogrel) treatment who were unable to discontinue the treatment because of a high risk for thromboembolic events were included. Patients had cataract extraction under topical anesthesia with a clear corneal incision (CCI), phacoemulsification, and implantation of a foldable posterior chamber intraocular lens. Prothrombin time-international normalized ratio and platelet functions were evaluated immediately before surgery. Patients were also examined 1 day and 7 days postoperatively. Intraoperative and postoperative ocular bleeding and other related complications were assessed.. Forty patients (51 eyes) with a mean age of 72 years (range 51 to 90 years) had phacoemulsification. Hemorrhagic complications were not observed at surgery or during the 1-week follow-up. Surgical complications included 1 rupture of the capsulorhexis and 1 implantation of a capsular tension ring due to partial zonulysis. No patient had a thromboembolic event.. In patients with uncomplicated cataract at high risk for thromboembolic events, phacoemulsification cataract surgery using a CCI under topical needle-free anesthesia was safely performed without discontinuing systemic anticoagulant and antiplatelet treatment.

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; Blood Loss, Surgical; Clopidogrel; Drug Therapy, Combination; Eye Hemorrhage; Female; Humans; Intraoperative Complications; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Platelet Aggregation Inhibitors; Postoperative Complications; Prospective Studies; Prothrombin Time; Risk Assessment; Thromboembolism; Ticlopidine; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Eye Hemorrhage; Humans; Ischemic Attack, Transient; Macular Degeneration; Male; Myocardial Ischemia; Visual Acuity; Warfarin

Topics: Anticoagulants; Cataract Extraction; Eye Hemorrhage; Guideline Adherence; Health Care Surveys; Humans; International Normalized Ratio; Medical Audit; Ophthalmology; Perioperative Care; Practice Guidelines as Topic; Practice Patterns, Physicians'; Societies, Medical; Surveys and Questionnaires; United Kingdom; Warfarin

To assess the risk for intraoperative and postoperative bleeding associated with antiplatelet and/or anticoagulant treatment in patients having uneventful phacoemulsification.. Kokura Memorial Hospital, Kitakyusyu, Japan.. In a nonrandomized case series, consecutive patients had phacoemulsification and intraocular lens implantation under sub-Tenon anesthesia. All patients were on warfarin, acetylsalicylic acid (aspirin) therapy, or both. Patients discontinued therapy 1 week before surgery (discontinuation group) or continued the therapeutic regimen until the time of surgery (maintenance group).. The discontinuation group comprised 182 patients and the maintenance group, 173 patients. There was no significant difference between the 2 groups in the mean prothrombin time-international normalized ratio in patients taking warfarin (P = .6). Although there was no significant intraoperative bleeding in any case, 47 eyes (16.5%) in the maintenance group and 31 eyes (10.8%) in the discontinuation group had a subconjunctival hemorrhage postoperatively (P = .0309). Minor postoperative ocular bleeding occurred in 11 eyes (4.0%) in the maintenance group and 7 eyes (2.5%) in the discontinuation group (P = .4). During the 1-month postoperative period, the mean change in corrected distance visual acuity was -0.462 logMAR +/- 0.331 (SD) in the maintenance group and -0.434 +/- 0.318 logMAR in the discontinuation group (P = .3).. Patients taking warfarin, aspirin, or both up to the time of phacoemulsification had a significantly higher incidence of subconjunctival hemorrhage than those who discontinued therapy. There was no significant difference between the 2 groups in the incidence of intraoperative and postoperative complications or in visual improvement.. The author has no financial or proprietary interest in any material or method mentioned.

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; Blood Loss, Surgical; Eye Hemorrhage; Female; Humans; Incidence; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Platelet Aggregation Inhibitors; Postoperative Hemorrhage; Visual Acuity; Warfarin

To assess the risk of hemorrhagic complications when performing intravitreal injections on systemically anticoagulated patients.. A single-center retrospective case series of 520 consecutive patients (675 eyes) receiving 3,106 antivascular endothelial growth factor injections. Patients on the systemic anticoagulants Coumadin (warfarin sodium) or Plavix (clopidogrel bisulfate) were identified, as well as patients on aspirin. Demographic parameters were recorded, as well as relevant anticoagulant medications, preoperative/postoperative best-corrected visual acuities and intraocular pressures, previous ocular surgery, relative ocular diagnoses, and injection complications.. Of all patients, 104 were on Coumadin (134 eyes; 548 injections), 90 were on Plavix (123 eyes; 523 injections), 7 were on both Coumadin and Plavix (8 eyes; 33 injections), and 319 were not anticoagulated (400 eyes; 2002 injections). Also, 1,254 injections were on patients taking aspirin. There were no hemorrhagic complications (choroidal hemorrhage, vitreous hemorrhage, or increased submacular hemorrhage) noted in the Plavix (P = 1.0000; 95% confidence interval = 0.0000-0.0088), Coumadin (P = 1.0000; 95% confidence interval = 0.0000-0.0084), or aspirin (P = 1.0000; 95% confidence interval = 0.0000-0.0037) groups.. The risk of hemorrhagic complications in systemically anticoagulated patients receiving intravitreal injections is extremely low. Because of the demonstrated thromboembolic risk of stopping anticoagulant therapy, we recommend that patients continue their current regiment without cessation.

Topics: Aged; Aged, 80 and over; Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Anticoagulants; Aspirin; Bevacizumab; Choroidal Neovascularization; Clopidogrel; Eye Hemorrhage; Female; Humans; Incidence; Intravitreal Injections; Macular Degeneration; Male; Middle Aged; Platelet Aggregation Inhibitors; Ranibizumab; Retrospective Studies; Risk Factors; Ticlopidine; Vascular Endothelial Growth Factor A; Warfarin

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

An 11-item questionnaire was mailed to 891 consultant members of the Royal College of Ophthalmologists (RCOphth) to audit compliance with RCOphth guidelines for perioperative management of anticoagulated patients having cataract surgery. Four hundred ninety-nine questionnaires were analyzed. The results showed that 29.5% of respondents adhered to all aspects of RCOphth guidelines; that is, they checked the international normalized ratio (INR) preoperatively, continued warfarin, operated within the desired therapeutic INR range for the condition that warfarin was being used to treat (as set by the treating physician), and considered sub-Tenon or topical anesthesia in anticoagulated patients.

Topics: Anticoagulants; Cataract Extraction; Eye Hemorrhage; Guideline Adherence; Health Care Surveys; Humans; International Normalized Ratio; Medical Audit; Ophthalmology; Perioperative Care; Practice Guidelines as Topic; Practice Patterns, Physicians'; Societies, Medical; Surveys and Questionnaires; United Kingdom; Warfarin

This study aims to establish the prevalence of aspirin, dipyridamole, clopidogrel, and warfarin use in patients undergoing cataract surgery, and to compare local anaesthetic and intraoperative complication rates between users and non-users.. The Cataract National Dataset was remotely extracted and anonymised on 55,567 operations at 12 NHS Trusts using electronic patient records (EPRs) between 2001 and 2006.. This report analyses 48,862 of the 55,567 operations from the eight centres, which routinely recorded a drug history. In all, 28.1% of the 48,862 patients were taking aspirin, 5.1% warfarin, 1.9% clopidogrel, and 1.0% dipyridamole. The recording of any complication of a sharp needle or subtenon's cannula local anaesthetic block was increased in patients taking clopidogrel, 8.0% (P<0.0001) or warfarin, 6.2% (P=0.0026) vs non-users, 4.3%, but no increase in potentially sight-threatening complications was identified. The incidence of subconjunctival haemorrhage was increased in patients taking clopidogrel, 4.4% (P<0.0001) or warfarin, 3.7% (P<0.0001) vs non-users, 1.7%. The recording of any operative complication was increased in those taking clopidogrel, 7.3% (P=0.0002) vs non-users, 4.4%, but the haemorrhagic operative complications of choroidal/suprachoroidal haemorrhage and hyphaema were not significantly increased. The non-haemorrhagic complication of posterior capsular rupture (PCR) was increased in those taking clopidogrel, 3.23% (P=0.0057) vs non-users, 1.77%.. Clopidogrel or warfarin use was associated with a significant increase in minor complications of sharp needle and subtenon's cannula local anaesthesia but was not associated with a significant increase in potentially sight-threatening local anaesthetic or operative haemorrhagic complications.

Topics: Aged; Anesthetics, Local; Anticoagulants; Aspirin; Blood Loss, Surgical; Cataract Extraction; Choroid Hemorrhage; Clopidogrel; Dipyridamole; Eye Hemorrhage; Humans; Intraoperative Complications; Lens Capsule, Crystalline; Platelet Aggregation Inhibitors; Risk Factors; Rupture; Ticlopidine; Warfarin

Topics: Angiogenesis Inhibitors; Anticoagulants; Aptamers, Nucleotide; Aspirin; Choroidal Neovascularization; Drug Therapy, Combination; Eye Hemorrhage; Humans; Incidence; Injections; Macular Degeneration; Risk Factors; Vascular Endothelial Growth Factor A; Vitreous Body; Warfarin

The management of patients on antiplatelet and anticoagulation therapy (APACT) in glaucoma surgery currently has no specific recommendations. We aimed to establish the risk of haemorrhagic complications and surgical outcome in patients on APACT in glaucoma surgery.. We retrospectively examined 367 consecutive trabeculectomies performed between 1994 and 1998. Preoperatively 60 (16.4%) patients were on APACT (55 on aspirin and five on warfarin). The incidence of hyphaema and haemorrhagic complications between patients with and without APACT was documented. Surgical success was defined in two categories as an intraocular pressure (IOP) <21 mmHg and an IOP <16 mmHg 2 years following trabeculectomy with and without antiglaucoma medication.. None of the patients on aspirin suffered significant intra or postoperative haemorrhage. Aspirin was associated with a significantly higher risk of hyphaema (P=0.0015) but this was not found to significantly affect IOP control at 2 years. Patients on warfarin suffered haemorrhagic complications and trabeculectomy failure.. Aspirin appears to be safe to continue with during trabeculectomy. Patients on aspirin have an increased risk of hyphaema following trabeculectomy. This however does not appear to affect surgical outcome. Warfarinised patients are at risk of serious bleeding complications. They require careful monitoring pre- and postoperatively and are at risk of trabeculectomy failure.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Antihypertensive Agents; Aspirin; Blood Loss, Surgical; Child; Drug Administration Schedule; Epidemiologic Methods; Eye Hemorrhage; Glaucoma; Humans; Hyphema; Intraocular Pressure; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Hemorrhage; Trabeculectomy; Treatment Outcome; 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

To evaluate the safety of intravitreal Macugen (OSI/Eyetech, New York, New York, USA) injections among patients receiving warfarin anticoagulation.. Retrospective chart review.. A search was conducted for patients treated with intravitreal Macugen for choroidal neovascularization resulting from age-related macular degeneration (AMD). Inclusion criteria included patients receiving warfarin anticoagulation in whom therapy was maintained.. The review identified 31 patients (32 eyes) who underwent 102 intravitreal Macugen injections while receiving warfarin anticoagulation. The mean and median number of Macugen injections per patient was three. No intraoperative or immediate postoperative hemorrhagic complications were noted. One patient experienced an acute submacular hemorrhage 35 days after the third Macugen injection. There were no other hemorrhagic events among the remaining patients.. The retrospective chart review of patients treated with intravitreal Macugen for choroidal neovascularization resulting from AMD while receiving warfarin therapy suggests that patients may undergo intravitreal injections safely without cessation of anticoagulation therapy.

Topics: Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anticoagulants; Aptamers, Nucleotide; Aspirin; Celecoxib; Choroidal Neovascularization; Drug Therapy, Combination; Eye Hemorrhage; Female; Humans; Injections; Macular Degeneration; Male; Middle Aged; Pyrazoles; Retrospective Studies; Sulfonamides; Vascular Endothelial Growth Factor A; Vitreous Body; Warfarin

To assess the risks of intra- and postoperative bleeding tendency associated with uncomplicated cataract surgery by phacoemulsification in patients receiving Coumadin treatment.. Prospective, nonrandomized, interventional, consecutive case series.. Sixty-three consecutive patients underwent cataract extraction with lens implantation in 75 eyes. All patients were receiving Coumadin therapy at the time of surgery, and nine patients (14.3%) were also taking antiaggregants. The operations were performed by phacoemulsification technique under topical anesthesia. All patients underwent a hemostatic work-up before intervention. Structured questionnaires were completed by the surgeon immediately after the operation. In 18 (24%) eyes, the surgery was videotaped, and the tapes were reviewed subsequently for any bleedings by an independent observer.. Twelve patients (19%) underwent surgery in both eyes, not simultaneously. The mean prothrombin time international normalized ratio (INR) was 2.03 at the time of the surgery. No significant intraoperative bleeding occurred. Four (6.3%) patients had minor postoperative ocular bleeding. A microscopic hyphema and a dot retinal hemorrhage were each seen in one eye on the first postoperative day, and small iris hemorrhages were identified in two additional eyes at the one-week visit. All bleedings disappeared within one week without affecting the visual acuity. The mean INR of the four patients with minor bleedings was 2.1.. Cataract surgery by phacoemulsification in uncomplicated eyes can be performed safely in patients receiving Coumadin treatment. However, a large clinical trial is required to assess the safety of continuous Coumadin treatment associated with phacoemulsification in eyes with complicated cataract.

Topics: Aged; Aged, 80 and over; Anticoagulants; Blood Loss, Surgical; Eye Hemorrhage; Female; Humans; International Normalized Ratio; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Postoperative Hemorrhage; Prospective Studies; Prothrombin Time; Risk Assessment; Surveys and Questionnaires; Warfarin

Topics: Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Anticoagulants; Bevacizumab; Eye Hemorrhage; Humans; Injections; Ophthalmologic Surgical Procedures; Ranibizumab; Risk Factors; Stroke; Thromboembolism; Vascular Endothelial Growth Factor A; Vitrectomy; Vitreous Body; Warfarin; Withholding Treatment

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

Topics: Aged, 80 and over; Anticoagulants; Eye Hemorrhage; Female; Humans; Warfarin

Topics: Anticoagulants; Aspirin; Cataract Extraction; Eye Hemorrhage; Humans; Middle Aged; Prospective Studies; Risk Factors; Warfarin

Topics: Adult; Anticoagulants; Antifungal Agents; Candidiasis; Choroid Hemorrhage; Drug Interactions; Endophthalmitis; Eye Hemorrhage; Eye Infections, Fungal; Fluconazole; Humans; Male; Retinal Hemorrhage; Ultrasonography; Vitreous Hemorrhage; Warfarin

Topics: Aged; Anticoagulants; Eye Hemorrhage; Humans; Macular Degeneration; Risk Factors; Vision Disorders; Warfarin

A massive intraocular hemorrhage in the course of age-related macular degeneration (AMD) is a devastating event. We set out to determine the role of anticoagulant therapy prescribed for vascular or cardiac indications in the development of a massive hemorrhage.. A retrospective case-controlled study was conducted of 50 cases of age-related macular degeneration complicated by massive subretinal and vitreous hemorrhage. The control group consisted of 50 cases of AMD with small subretinal hemorrhage.. There was a significant difference in the use of anticoagulant medication (warfarin sodium) between the groups. The difference in the use of antiplatelet medication (aspirin) between the groups was not significant. A patient with a massive intraocular hemorrhage and AMD is 11.6 times more likely to use anticoagulant medication. It appeared that more than 50% of the patients in the massive hemorrhage group were allowed to stop the anticoagulant medication.. Anticoagulant medication poses a significant risk in the development of a massive intraocular hemorrhage in patients with exudative AMD. Antiplatelet medication poses a less significant risk. Physicians prescribing anticoagulant medication should be informed about the macular status of the patient. the In case of neovascular AMD, anticoagulant medication should be prescribed only for absolute systemic indications.

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; Drug Prescriptions; Eye Hemorrhage; Female; Humans; Macular Degeneration; Male; Middle Aged; Odds Ratio; Platelet Aggregation Inhibitors; Retrospective Studies; Risk Factors; Ultrasonography; Visual Acuity; Vitreous Hemorrhage; Warfarin

Cataract extraction in the warfarinized patient poses special considerations. Warfarin will increase the haemorrhagic risk but, more importantly, cessation or reduction in anticoagulation may well lead to serious thromboembolic phenomena. The purpose of this study was to assess the impact that warfarinization has on cataract extraction.. One thousand consecutive cataract extractions performed at Christchurch Hospital between 1996 and 1998 were reviewed. Twenty-eight patients (29 eyes) were on warfarin. Reasons for anticoagulation, modification to treatment regimen and postoperative outcome measures were available for 23 eyes or 79% of the study population.. The preoperative international normalized ratio (INR) ranged from 1.00 to 2.40+/-0.37 with a mean of 1.52. No thromboembolic phenomena occurred and four minor perioperative haemorrhages were noted, none of which affected the final visual outcome.. If warfarin is required to counteract serious thromboembolic tendencies, then it should not be ceased perioperatively. The small numbers of perioperative haemorrhages that did occur were not visually significant.

Topics: Anesthesia, Local; Anticoagulants; Cataract Extraction; Cerebrovascular Disorders; Coronary Disease; Eye Hemorrhage; Female; Humans; Male; Retrospective Studies; 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

Topics: Anticoagulants; Drug Monitoring; Eye Hemorrhage; Female; Humans; Middle Aged; Patient Education as Topic; Scleral Diseases; Warfarin

We analyzed data of 50 patients receiving long-term warfarin sodium therapy who underwent ocular surgery between 1982 and 1986. The frequency of hemorrhagic and thrombotic complications was compared in patients in whom anticoagulants were continued, those in whom the anticoagulants were discontinued in the perioperative period, and a group of matched control patients. There were six perioperative hemorrhagic complications in the warfarin-treated group (12%) compared to none in the control group. This difference was significant (P less than .03). However, no significant difference in hemorrhagic complications was seen between patients in whom warfarin sodium was continued and those in whom it was discontinued.

Topics: Adult; Aged; Aged, 80 and over; Cataract Extraction; Eye Hemorrhage; Female; Follow-Up Studies; Humans; Intraoperative Care; Lenses, Intraocular; Male; Middle Aged; Postoperative Complications; Prothrombin Time; Thrombosis; Time Factors; Warfarin

A seventy-two-year-old white male developed bleeding from a right eye subconjunctival hemorrhage. The patient had been taking warfarin and, it was immediately discontinued. Two doses of 15 mgs. each of vitamin K given parentally reduced the prothrombin time, but not the oozing of blood which finally stopped after the administration of fresh frozen plasma. Fortunately, no retrobulbar or intra-ocular bleeding occurred. This complication during the use of anticoagulants has never, to our knowledge, been reported before in the medical literature.

Topics: Aged; Eye Hemorrhage; Humans; Male; Tears; Warfarin