warfarin and Glaucoma

Topics: Alcohol Oxidoreductases; Catalase; Cholinesterases; Dicumarol; Diseases in Twins; Drug Hypersensitivity; Drug Resistance; Drug-Related Side Effects and Adverse Reactions; Environment; Female; Genetic Diseases, Inborn; Glaucoma; Glucosephosphate Dehydrogenase Deficiency; Hemoglobins; Humans; Infant, Newborn; Intraocular Pressure; Isoniazid; Malignant Hyperthermia; Mutation; Pharmaceutical Preparations; Pharmacogenetics; Phenylthiourea; Phenytoin; Pregnancy; Protein Binding; Racial Groups; Warfarin

To identify the practices of ophthalmologists when undertaking glaucoma surgery on patients concurrently using warfarin or acetylsalicylic acid (aspirin).. A questionnaire was designed to examine perioperative management of patients being treated with warfarin and aspirin prior to and during glaucoma surgery. The questionnaire was posted with stamped self-addressed envelopes to all glaucoma specialists registered on a glaucoma shared care scheme database.. Of the 93 eligible participants, 64 returned a completed questionnaire, representing a response rate of 68.8%. Twenty-one surgeons (32.8%) routinely stopped warfarin before surgery. Mean time prior to surgery of drug cessation was 4 days (range 2-7). Three surgeons (14.3%) routinely commenced heparin if they stopped warfarin. Ten (47.6%) never used heparin, while the remaining eight (38.1%) would use heparin depending upon the indication for anticoagulation. Forty-two surgeons (81.25%)were happy to operate only at an INR < or =3 at the time of surgery. The remainder (18.75%) were happy to operate at higher INRs, including two surgeons (3.1%) who would operate at any level. Twenty surgeons (31.2%) routinely stopped aspirin before surgery, while the rest did not. Of those who stopped aspirin, the mean time prior to surgery was 7.1 days (range 4-14 days).. The majority of surgeons do not stop warfarin or aspirin prior to glaucoma surgery. There is a great diversity in current practice with regard to the management of anticoagulant therapy prior to glaucoma surgery amongst glaucoma surgeons in England. Currently there is little information available to offer definitive guidance.

Topics: Anticoagulants; Aspirin; Blood Loss, Surgical; Glaucoma; Humans; International Normalized Ratio; Ophthalmology; Practice Patterns, Physicians'; Surveys and Questionnaires; Time Factors; Trabeculectomy; 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

To investigate risk factors for central retinal vein occlusion (CRVO).. Retrospective case-control study.. Consecutive patients with CRVO examined from July 1, 2005 through July 31, 2006 were compared with an historical gender- and age-matched control group of patients with ocular problems other than vascular occlusive disease from the same referral practice. Risk factors for CRVO were evaluated.. The 144 patients in the CRVO group, 87 males and 57 females, had a mean age of 69.6 years (+/-13.6 years). CRVO was associated with hypertension (P < .001), diabetes mellitus (P = .047), glaucoma (P < .001), atrial fibrillation (P = .036), angiotensin-converting enzyme inhibitor use (P = .022), aspirin use (P < .001), and warfarin use (P = .011) by univariate analyses. Postmenopausal estrogen use was more common among women in the control group (P = .029). Multivariate logistic regression found the independent predictors for CRVO to be: glaucoma (adjusted odds ratio [OR], 4.75; P < .001), aspirin use (adjusted OR, 2.66; P = .001), and warfarin use (adjusted OR, 3.34; P = .005).. We found many of the same risk factors previously identified for CRVO by other studies, but we identified both aspirin and warfarin use to be independent risk factors for CRVO. Although these findings suggest the vasculopathic and prothrombotic risks in some patients may not be addressed adequately by antithrombotic therapy, they also suggest that the pathogenesis of CRVO may be more complicated than just the development of a primary thrombus within the vein.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aspirin; Case-Control Studies; Female; Glaucoma; Humans; Male; Middle Aged; Retinal Vein Occlusion; Retrospective Studies; Risk Factors; Warfarin

To describe an unusual hemorrhagic complication associated with pupillary dilation in a patient with exfoliation glaucoma taking anticoagulation therapy.. A 78-year-old woman with bilateral exfoliation glaucoma who was receiving warfarin, 2 mg daily, for systemic anticoagulation developed acute visual loss in the right eye several hours after pupillary dilation.. Examination disclosed bilateral advanced exfoliation glaucoma, localized vascularized iridolenticular adhesions in the right eye, and a 4-mm layered hyphema in the right eye.. Patients with exfoliation glaucoma and vascularized posterior synechiae who are receiving anticoagulation therapy are at increased risk for visually significant spontaneous hyphema after pupillary dilation.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Carbachol; Cerebrovascular Disorders; Drug Therapy, Combination; Exfoliation Syndrome; Female; Glaucoma; Humans; Hyphema; Latanoprost; Propranolol; Prostaglandins F, Synthetic; Pupil; Warfarin

A 66-year-old woman receiving anticoagulant therapy experienced a spontaneous massive subretinal hemorrhage that led to blindness and intractable glaucoma in the involved eye and necessitated enucleation. Clinical and histopathological observations suggested that the bleeding originated from blood vessels within an area of disciform macular degeneration. If the patient had not been receiving anticoagulant therapy the hemorrhage would presumably have been more limited.

Topics: Aged; Anticoagulants; Blindness; Female; Glaucoma; Humans; Macular Degeneration; Middle Aged; Retinal Hemorrhage; Ultrasonography; Warfarin

Topics: Aqueous Humor; Cataract Extraction; Diabetes Mellitus; Diagnosis, Differential; Eye Neoplasms; Geriatrics; Glaucoma; Humans; Macula Lutea; Macular Degeneration; Pathology; Postoperative Complications; Retinal Detachment; Retinal Hemorrhage; Warfarin