warfarin and Macular-Degeneration

The aim of this study was to evaluate the effects of chronic use of acetylsalicylic acid (ASA) and vitamin K antagonists (VKA) on the incidence of age related macular degeneration (AMD).. The study included 292 individuals (187 women, 105 men, aged 45-94 (mean 73.2 ± 10.2 years). All individuals completed a survey and underwent a full eye examination. Patients were divided into four groups according to the presence or absence of degenerative changes at the bottom of an eye: group D - 80 patients with drusen (23 men and 57 women), 27,4% of studied population, group GA - 25 patients with geographic atrophy (10 men, 15 women), 8,56% of studied population, group CNV - 52 patients with neovascular form of AMD (28 men, 24 women), 17,81% of studied population, group Z - 135 healthy people (44 men, 91 women), 46,23% of studied population. Among study group 79 patients (27,1%) used aspirin, 32 people (11%) used vitamin K antagonists (acenocoumarol or warfarin), 181 people (61,9%) didn't use any drug.. Patients from D and CNV group took ASA and VKA more often than patients from GA and Z group. The percentages were: in a group Z - 30,37%, in group D - 46,25%, in group GA - 32%, in group CNV - 48,08% (p=0,0407). There was no relationship between belonging to a group and use of ASA (p=0,3169). A statistically significant relationship between belonging to a group and use of VKA was discovered. The number of people using VKA in group D and CNV was statistically significantly higher than in the healthy control group and percentage were as follows: in group Z - 8,15%, in group D - 17,5%, in group GA 0%, in group CNV - 13,46% (p=0,0159). Patient groups differed statistically significantly due to age (p=0,0043), sex (p=0,0197), family history of macular diseases (p <0,0001), smoking (p=0,011), prevalence of hypercholesterolemia (p=0,0437), ischemic heart disease (p= 0,0173). The consumption of fish at least once a week and eating fruits and vegetables more often than once a day was associated with a reduced incidence of AMD p=0,0009, p=0,0003. Patients without AMD assessed their quality of life at a higher level than people with AMD (p<0,0001). ASA and VKA intake was found not to be an independent risk factor for AMD. Positive family history was an independent risk factor for AMD in all groups. Also age ≥75, fish consumption > 1 week, male gender were independent risk factors for AMD in specified groups.. Patients with drusen and exudative form of AMD took ASA and VKA more often than healthy people and patients with geographic atrophy. ASA or VKA intake was found not to be an independent risk factor for AMD. Positive family history was an independent risk factor for AMD in all groups. In selected groups: age ≥75, male gender and reduced consumption of fish was found to be an independent risk factor for AMD. Number of people taking ASA and VKA is increasing and further studies are needed to assess their impact on the organ of vision.

Topics: Acenocoumarol; Aged; Anticoagulants; Aspirin; Case-Control Studies; Causality; Comorbidity; Female; Humans; Hypercholesterolemia; Incidence; Macular Degeneration; Male; Population Surveillance; Prevalence; Risk Factors; Smoking; Vitamin K; Warfarin

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

Topics: Aged, 80 and over; Anticoagulants; Drug Interactions; Health Knowledge, Attitudes, Practice; Hemorrhage; Humans; Macular Degeneration; Vitamin E; 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

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

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 describe the course, management, and prognosis of massive spontaneous choroidal hemorrhage.. The presenting visual acuity, ocular findings, duration to surgical intervention, and outcomes of five patients were retrospectively reviewed.. Five eyes from four patients (median age, 80 years; range, 66-85 years) were studied. The patients were observed from 4 to 72 months (median, 33 months). Three patients were on anticoagulation therapy with warfarin; one patient had bilateral involvement with no history of anticoagulation therapy. Three patients were hypertensive, and three of the four had been diagnosed with age-related macular degeneration. Four eyes underwent choroidal drainage procedures, and one was observed. In all patients whose choroids were drained, the final vision was no light perception.. Massive spontaneous choroidal hemorrhage may be associated with hypertension, systemic anticoagulation, advanced age, and age-related macular degeneration. Final visual acuities are generally poor.

Topics: Age Factors; Aged; Aged, 80 and over; Anticoagulants; Choroid Hemorrhage; Female; Humans; Hypertension; Longitudinal Studies; Macular Degeneration; Male; Outcome Assessment, Health Care; Prognosis; Retrospective Studies; Visual Acuity; Warfarin

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Blindness; Choroid Hemorrhage; Female; Humans; Macular Degeneration; Warfarin

Topics: Aged; Aged, 80 and over; Anticoagulants; Choroid Hemorrhage; Female; Humans; Macular Degeneration; 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

Age-related macular degeneration (ARMD) is the leading cause of legal blindness in the elderly, causing profound loss of central vision.. A 90-year-old patient with exudative age-related macular degeneration who had been placed on anticoagulant therapy for pulmonary emboli experienced a massive choroidal hemorrhage and retinal detachment. Angle closure glaucoma was precipitated by forward movement of the iris-lens diaphragm and vision was lost in the eye. The patient was subsequently removed from anticoagulant therapy, although he had potentially fatal bilateral pulmonary emboli, because of the patient's concern for the quality of his remaining life.. This case report is intended to alert optometrists to the ocular complications of anticoagulant therapy, particularly the risk of massive choroidal hemorrhage in anticoagulated patients with exudative ARMD.. An optometrist's responsibility to inform primary care providers of the potential ocular complications of anticoagulant therapy for patients with exudative ARMD is also described.

Topics: Aged; Aged, 80 and over; Anticoagulants; Choroid Hemorrhage; Fundus Oculi; Glaucoma, Angle-Closure; Humans; Macular Degeneration; Male; Pulmonary Embolism; Retinal Detachment; 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