warfarin and Hyphema

To report a case of bilateral spontaneous hyphaema in a patient on warfarin sodium for atrial fibrillation and COPD. A case report and literature review. A 76-year-old man presented with bilateral spontaneous hyphaema. There was no anterior chamber pathology known to predispose for spontaneous bleeding except for a history of paroxysmal atrial fibrillation treated with a daily dose of 3 mg of warfarin sodium. In addition, he was also suffering from severe COPD and was on oxygen supplementation. This is a rare case of a bilateral spontaneous hyphaema. Although the patient was on warfarin sodium, his INR was only 2.6 at the onset of his symptoms. It may be possible that the combined action of anti-coagulant properties of warfarin sodium and hypoxic vasodilatation of iris vessels may be responsible for bilateral hyphaema in this case.

Topics: Aged; Humans; Hyphema; Hypoxia; Iris; Male; Pulmonary Disease, Chronic Obstructive; Vasodilation; Warfarin

To our knowledge, this is the first study to describe the correlation of anterior chamber bleeding after laser peripheral iridotomy (LPI) and antiplatelet therapy.. To determine the incidence and amount of anterior chamber bleeding after laser peripheral iridotomy in patients whose condition is suggestive of primary angle-closure glaucoma (PACS) who continued their antiplatelet or anticoagulant treatment before undergoing LPI compared with when they discontinued treatment.. A prospective controlled trial.. Patients with suspected bilateral primary angle-closure and no other ocular disease who take antiplatelet or anticoagulant medications regularly (from January 2010-October 2011) were enrolled.. The incidence of anterior chamber bleeding with and without antiplatelet and anticoagulant therapy.. A total of 104 patients (208 eyes) participated in the study. Thirty-six eyes (34.6%) in the treated and untreated arms bled. The amount of bleeding did not differ significantly when the patient was on or off antiplatelet or anticoagulant treatment, nor did the immediate postprocedure mean intraocular pressure (P = .13). The type of antiplatelet or anticoagulant, total laser energy, age, sex, or color of irides were not risk factors for increased bleeding (P = .156 for all parameters).. No indication was noted for discontinuing these medications before a high-powered pulsed laser peripheral iridotomy.

Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Anticoagulants; Aspirin; Clopidogrel; Eye Color; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Hyphema; Incidence; Intraocular Pressure; Iridectomy; Iris; Laser Therapy; Lasers, Solid-State; Male; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Complications; Prospective Studies; Risk Factors; Ticlopidine; Tonometry, Ocular; 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

Topics: Aged; Anticoagulants; Dose-Response Relationship, Drug; Eye Diseases; Female; Humans; Hyphema; Pain; Treatment Outcome; 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 describe a technique of suture fixating posterior chamber silicone intraocular lenses (PC IOLs) to the iris through a limbal incision and to evaluate its effectiveness in preventing intraocular hemorrhages.. Price Vision Group, Indianapolis, Indiana, USA.. This retrospective single-center study comprised 7 eyes (5 patients) that had suture fixation of a silicone PC IOL from a limbal approach to the midperipheral iris using 9-0 polypropylene (Prolene(R)) suture. All patients were taking warfarin sodium (Coumadin(R)) preoperatively and postoperatively. At each follow-up examination, visual acuity and intraocular pressure were measured, the stability of the PC IOL was assessed, and the anterior chamber and posterior segment were evaluated for blood.. There was no incidence of intraocular hemorrhage during surgery in any eye. In 6 eyes, there was no blood in the anterior chamber or posterior segment at any postoperative examination. A nonlayering hyphema that resolved within 1 week without sequelae was noted in 1 patient 6 weeks postoperatively. The mean follow-up was 10.7 months (range 6 to 25 months).. Suture fixating a PC IOL to the iris through a limbal approach was an effective means of placing an IOL in anticoagulated patients without capsule support.

Topics: Adult; Aged; Anticoagulants; Biocompatible Materials; Humans; Hyphema; Intraocular Pressure; Iris; Lens Implantation, Intraocular; Lenses, Intraocular; Middle Aged; Polypropylenes; Retrospective Studies; Silicone Elastomers; Suture Techniques; Sutures; Visual Acuity; Vitreous Hemorrhage; Warfarin

Topics: Aged; Anticoagulants; Blood Loss, Surgical; Cataract Extraction; Female; Humans; Hyphema; Lens Implantation, Intraocular; Male; Prospective Studies; Safety; 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

Topics: Aged; Anticoagulants; Female; Humans; Hyphema; Vision Disorders; 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

Ten cataract extractions were performed on eight patients for whom warfarin was not discontinued prior to surgery. Three were complicated by hyphaema. No retrobulbar haemorrhages occurred in the four cases given a local anaesthetic. Cataract surgery can be performed successfully without discontinuing warfarin.

Topics: Aged; Aged, 80 and over; Anesthesia, General; Anesthesia, Local; Cataract Extraction; Female; Humans; Hyphema; Male; Warfarin

Topics: Aged; Humans; Hyphema; Lenses, Intraocular; Male; Middle Aged; Recurrence; 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

Topics: Cataract Extraction; Humans; Hyphema; Lenses, Intraocular; Postoperative Complications; Prothrombin Time; Warfarin

Spontaneous hyphemas in iris supported intraocular lenses are considerably more likely to occur in patients on systemic Coumadin therapy. Five cases are presented in which hyphemas appear to be related to Coumadin treatment.

Topics: Aged; Aphakia, Postcataract; Female; Humans; Hyphema; Iris; Lenses, Intraocular; Male; Warfarin

Systemic anticoagulation rarely is responsible for intraocular hemorrhaging and usually does not require cessation before intraocular surgery. Spontaneous hyphema is only rarely described and then usually in patients who have some underlying vascular abnormality. A case is reported of a patient with no other underlying cause except that she was receiving warfarin sodium, in whom spontaneous hyphemas developed in each eye on two separate occasions.

Topics: Female; Humans; Hyphema; Middle Aged; Visual Acuity; Warfarin