warfarin and Retinal-Diseases

To estimate the risk of hemorrhagic complications associated with 25-gauge pars plana vitrectomy (PPV) when warfarin (Coumadin; Bristol-Myers Squibb, New York, NY) or clopidogrel (Plavix; Bristol-Myers Squibb) are continued throughout the surgical period, as compared with a control group.. A single-center, retrospective, cohort study of 289 consecutive patients receiving either warfarin therapy or clopidogrel therapy or neither of those therapies who underwent 25-gauge PPV.. Included were 61 patients (64 eyes; 64 PPV procedures) in the warfarin group and 118 (125 eyes; 136 PPV procedures) in the clopidogrel group. Warfarin patients were subdivided into 4 groups by international normalized ratio (INR). A control group included 110 patients (110 eyes; 110 PPV procedures) who were not receiving warfarin or clopidogrel.. Retrospective chart review for which the criteria included: 25-gauge PPV, minimum age of 19 years, warfarin or clopidogrel use, and, if taking warfarin, an INR obtained within 5 days of surgery.. Incidence of intraoperative and postoperative hemorrhagic complications.. The most common indications for anticoagulation therapy included: atrial fibrillation (38%), valvular heart disease (17%), and thromboembolic disease (16%). The most common indications for antiplatelet therapy included: cardiac stent (49%), coronary artery bypass grafting (24%), and history of transient ischemic attack (16%). No patient experienced anesthesia-related hemorrhagic complications resulting from peribulbar or retrobulbar block. Transient vitreous hemorrhage occurred in 1 (1.6%) of 64 PPV procedures in the warfarin group (P = 0.6531), 5 (3.7%) of 136 PPV procedures in the clopidogrel group (P = 1.0), and 4 (3.6%) of 110 PPV procedures in the control group. No choroidal or retrobulbar hemorrhages occurred in any patient.. The rate of 25-gauge PPV hemorrhagic complications in patients who underwent systemic anticoagulation or who were receiving platelet inhibitor therapy is extremely low. Given the risks associated with stopping these therapies, the authors recommend that patients continue their current therapeutic regimen without cessation.

Topics: Aged; Anticoagulants; Cardiovascular Diseases; Choroid Hemorrhage; Clopidogrel; Humans; Incidence; Intraocular Pressure; Intraoperative Complications; Microsurgery; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Complications; Retinal Diseases; Retrobulbar Hemorrhage; Retrospective Studies; Risk Factors; Ticlopidine; Visual Acuity; Vitrectomy; Vitreous Hemorrhage; Warfarin

Topics: Anticoagulants; Atrial Fibrillation; Drug Administration Schedule; Heparin, Low-Molecular-Weight; Humans; International Normalized Ratio; Ophthalmologic Surgical Procedures; Postoperative Complications; Preoperative Care; Retinal Diseases; Stroke; Thromboembolism; Warfarin; Withholding Treatment

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: Anticoagulants; Atrial Fibrillation; Humans; Postoperative Complications; Retinal Diseases; Retrospective Studies; Risk Factors; Vitrectomy; Vitreous Hemorrhage; Warfarin

Antiphospholipid syndrome, also known as Hughes syndrome, is a recently described entity that mimics symptoms of other diseases such as multiple sclerosis. It is a potentially life-threatening autoimmune disorder where the body produces antibodies directed against phospholipids and phospholipid-binding proteins. Herein a patient with successive ocular vascular events associated with antiphospholipid syndrome is presented.

Topics: Adult; Antibodies, Antiphospholipid; Anticoagulants; Antiphospholipid Syndrome; Humans; Lupus Coagulation Inhibitor; Male; Retinal Diseases; Retinal Vessels; Warfarin

To evaluate the risk of hemorrhagic complications associated with vitreoretinal surgery in patients whose warfarin sodium therapy was continued throughout the surgical period.. A review of 1737 records of patients undergoing pars plana vitrectomy was conducted. Inclusion criteria included patients receiving warfarin therapy whose international normalized ratios (INRs) were elevated above normal values on the day of surgery. Intraoperative and postoperative hemorrhagic complications were documented.. Fifty-four patients underwent 57 vitreoretinal surgical procedures with warfarin therapy and were divided into groups as follows: group S with INRs of 1.20 to 1.49, values considered subtherapeutic; group B with INRs of 1.50 to 1.99, values considered borderline therapeutic; group T with INRs of 2.00 to 2.49, values considered therapeutic; and group HT with INRs of 2.50 or greater, values considered highly therapeutic. No patients experienced anesthesia-related or intraoperative hemorrhagic complications. Two (7.7%) of 26 eyes in group S and 2 (16.7%) of 12 eyes in group HT experienced postoperative hemorrhages. All of the patients with vitreous hemorrhages had spontaneous clearing without additional treatment.. Many patients may safely undergo vitreoretinal surgery while maintaining therapeutic levels of warfarin anticoagulation. We experienced no intraoperative hemorrhagic complications; the 4 postoperative complications resolved spontaneously without persistent visual sequelae or the need for supplemental surgery.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Humans; International Normalized Ratio; Intraoperative Complications; Male; Middle Aged; Partial Thromboplastin Time; Postoperative Complications; Prothrombin Time; Retinal Diseases; Retrospective Studies; Risk Factors; Vitrectomy; Vitreous Hemorrhage; Warfarin

The purpose of this study was to evaluate the risk of hemorrhagic complications associated with vitreoretinal surgery in patients in whom warfarin therapy was continued throughout the surgical period.. A review of 1,737 consecutive charts of patients undergoing pars plana vitrectomy was conducted. Inclusion criteria included patients on warfarin therapy whose international normalized ratio (INR) was elevated above normal on the day of vitreoretinal surgery. The occurrence of intraoperative and postoperative hemorrhagic complications was documented.. The retrospective review detected 54 patients who underwent 57 vitreoretinal surgical procedures while on warfarin therapy. Group S consisted of patients whose INR ranged from 1.2 to 1.49, values that were considered to be subtherapeutic. Group B had INR values ranging from 1.5 to 1.99, values that were considered to be borderline therapeutic. Group T had INRs ranging from 2.0 to 2.49, values that were considered therapeutic. Group HT had INRs of 2.5 or greater, values that were considered highly therapeutic. No patients experienced anesthesia-related or intraoperative hemorrhagic complications. Four procedures (7.0%) were complicated by postoperative hemorrhage. Two of 26 eyes (7.7%) in group S and two of 12 eyes (16.7%) in group HT experienced postoperative hemorrhages. All hemorrhagic complications cleared without additional therapy.. Our findings suggest that many patients may safely undergo vitreoretinal surgery while maintaining therapeutic levels of warfarin anticoagulation. We found no intraoperative hemorrhagic complications. Those hemorrhagic complications that occurred postoperatively resolved spontaneously without persistent visual sequelae or the need for supplemental surgery.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Humans; International Normalized Ratio; Intraoperative Complications; Male; Middle Aged; Partial Thromboplastin Time; Postoperative Complications; Prothrombin Time; Retinal Diseases; Retrospective Studies; Risk Factors; Vitrectomy; Vitreous Hemorrhage; Warfarin

Susac's syndrome is a rare disease of unknown aetiology affecting the small vessels of the retina, brain, and cochlea. We present the case of a 55-year-old female, the oldest patient yet described with the condition, and highlight the syndrome's clinical features.

Topics: Anti-Inflammatory Agents; Anticoagulants; Cerebral Angiography; Cerebrovascular Disorders; Cochlear Diseases; Cognition Disorders; Female; Hearing Disorders; Humans; Methylprednisolone; Middle Aged; Retinal Diseases; Syndrome; Warfarin

Topics: Adult; Arterial Occlusive Diseases; Autoantibodies; Blood Coagulation Factors; Humans; Lupus Coagulation Inhibitor; Male; Retinal Artery; Retinal Diseases; Vision Disorders; Warfarin