warfarin and Vitreous-Hemorrhage

Antithrombotic therapy could be related with nuisance bleeding. This study investigated whether vitreous hemorrhage (VH) is associated with specific types of antithrombotic medication in patients with atrial fibrillation (AF).. In the Korean National Health Insurance Service National Sample Cohort, we identified 9352 antiplatelet/anticoagulant-treated AF patients. The occurrence of VH was compared between warfarin (n=1493) and a propensity score (PS)-matched antiplatelet group (n=1493) and between warfarin (n=1493) and a PS-matched warfarin+antiplatelet group (n=1493).. Dual antiplatelet or triple therapy increased the risk of VH significantly, compared to warfarin monotherapy. Considering the low efficacy of preventing ischemic stroke and high risk of bleeding, dual or triple therapy using warfarin and antiplatelet agents should be avoided to prevent VH in AF patients.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Cohort Studies; Female; Fibrinolytic Agents; Humans; Male; Middle Aged; National Health Programs; Platelet Aggregation Inhibitors; Propensity Score; Proportional Hazards Models; Republic of Korea; Risk Factors; Treatment Outcome; Vitreous Hemorrhage; Warfarin

Rivaroxaban is an anticoagulant prescribed for the management of atrial fibrillation. We describe a correlation between rivaroxaban and spontaneous vitreous hemorrhage.. Three patients developed spontaneous vitreous hemorrhage after initiating rivaroxaban anticoagulation. All 3 patients were taking an additional anticoagulant at the time of hemorrhage.. Rivaroxaban is increasingly prescribed as a replacement for warfarin sodium in the management of atrial fibrillation. Rivaroxaban anticoagulation may be associated with spontaneous vitreous hemorrhage. The risk of hemorrhage may be particularly elevated during the transition period when patients are switched from baseline anticoagulant to rivaroxaban therapy and are taking both anticoagulants simultaneously.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Clopidogrel; Factor Xa Inhibitors; Humans; Male; Platelet Aggregation Inhibitors; Rivaroxaban; Ticlopidine; Visual Acuity; Vitreous Hemorrhage; Warfarin

To determine if oral anticoagulation alters the association between vitreous hemorrhage (VH) and retinal tears in eyes with acute, posterior vitreous detachment (PVD).. In this retrospective chart review, the complete records of consecutive patients with spontaneous, symptomatic acute PVD from a single referral-based practice were reviewed. The use of oral anticoagulants, the presence of a VH, and the presence of a retinal tear or detachment were recorded.. A total of 336 consecutive eligible patients (336 eyes) were included in the final analysis. Vitreous hemorrhage occurred in 118 (35%) eyes; in 43% of patients taking aspirin, clopidogrel, or warfarin versus 31% not taking these medications (P = 0.03). Retinal tears occurred in 46% of patients with VH versus 27% of patients without VH (P = 0.0007). Retinal tears occurred in 39% of patients with VH taking aspirin, clopidogrel, or warfarin compared with 52% of patients not taking these medications. (P = 0.20) A decreased proportion of patients with acute PVD taking one or more of the oral anticoagulant medications studied, regardless of the presence of VH, were diagnosed with a retinal tear (P = 0.0017) or retinal detachment (P = 0.0001).. Retinal tears are commonly found (46%) in the eyes of patients who present with symptoms and signs of acute PVD and VH. Patients taking aspirin, clopidogrel, or warfarin who develop an acute PVD are more likely to present with VH. No statistically significant association was demonstrated between the use of oral anticoagulants in patients with acute PVD and VH and the presence of retinal tears or retinal detachment.

Topics: Acute Disease; Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Clopidogrel; Female; Humans; Male; Middle Aged; Retinal Detachment; Retinal Perforations; Retrospective Studies; Risk Assessment; Ticlopidine; Vitreous Detachment; Vitreous Hemorrhage; Warfarin

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

Warfarin is a commonly used anticoagulant whose effect in vitreoretinal surgery has not been well studied.. A series of 60 patients on warfarin therapy undergoing pars plana vitrectomy were retrospectively case controlled to 60 patients with similar presenting complaints. In addition, an online survey was performed of current practice in the UK.. 2% of the patients receiving vitrectomy were on warfarin. There were 33 males and 27 females with a median age of 72.5 years; follow-up was for a mean of 0.88 years. The international normalised ratio (INR) ranged between 0.94 and 4.6 (median 2.3). Two cases of suprachoroidal haemorrhages occurred in the control group (one with preoperative choroidal haemorrhage from dislocated lens nucleus), while none occurred in the warfarin group. 12 patients with rhegmatogenous retinal detachment (RRD) in the warfarin group presented with vitreous haemorrhage compared with only four in the control group (p=0.04). From the online survey, 48 respondents (81%) would ask patients to withhold warfarin prior to vitreoretinal surgery based on the INR.. There was no increase in complications in patients continuing to take warfarin compared with controls. Patients with RRD are more likely to have vitreous haemorrhage at presentation if they are on warfarin.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Contraindications; Female; Humans; International Normalized Ratio; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Practice Guidelines as Topic; Retinal Detachment; Retrospective Studies; Risk Factors; Scleral Buckling; United Kingdom; Vitreoretinal Surgery; Vitreous Hemorrhage; Warfarin

The purpose of this study was to provide further information about the risks of perioperative hemorrhage in diabetic vitrectomy in patients on anticoagulation. This may help us to better understand more about the fine balance between the risks of stopping anticoagulation versus continuation for intraocular surgery.. A retrospective, comparative cohort study of all patients undergoing a diabetic pars plana vitrectomy by a single surgeon over a 30-month period at a single institution was conducted.. Ninety-seven eyes were included for analysis. Twenty-seven eyes remained on anticoagulation during the surgery. There were no perioperative complications related to the anticoagulation. Surgical intervention resulted in a significant increase in visual acuity in both groups. There was no difference in the incidence of postoperative vitreous hemorrhage or surgical reoperation between the two groups. Patients on anticoagulation had significantly worse postoperative vision compared with those not on anticoagulation (best-corrected visual acuity of 20/230 vs. 20/100, P = 0.03).. Patients undergoing diabetic vitrectomy, who are on anticoagulation or antiplatelet agents, do not exhibit a higher risk of intraoperative or postoperative vitreous hemorrhage. Anticoagulants and antiplatelets may be safely continued perioperatively to avoid complications secondary to their systemic disease.

Topics: Anticoagulants; Aspirin; Clopidogrel; Diabetic Retinopathy; Female; Humans; Incidence; Intraoperative Complications; Male; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Complications; Retrospective Studies; Risk Factors; Ticlopidine; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreous Hemorrhage; Warfarin

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

No substantial recommendations exist regarding the management of anticoagulant drugs prior to ocular surgery. Stopping anticoagulation can cause fatal emboli, but sight-threatening bleeds may occur if anticoagulation is continued. We examined the effects of anticoagulation on vitreoretinal surgery.. Clinical details were prospectively entered on a database. The anticoagulant status of 541 consecutive patients undergoing vitreoretinal surgery was recorded.. Sixty patients in the study were taking aspirin and seven were taking warfarin. There were 11 cases of choroidal haemorrhage, one of which involved a warfarin user. Of 325 retinal detachment repairs, 21 (6.5%) had preoperative vitreous haemorrhages. Two of these patients were on aspirin and two were on warfarin. Sixty-six vitrectomies were performed for diabetic vitreous haemorrhages, of which nine re-bled postoperatively. One of these patients was taking warfarin. The association of warfarin with bleeding was statistically significant (relative risk 6.185).. Anticoagulation had no effect on the number of significant perioperative (choroidal) haemorrhages. Aspirin had little effect on bleeding during vitreoretinal surgery. Warfarin, however, was associated with bleeding complications. We suggest that aspirin should not be stopped prior to surgery. Warfarin may be stopped if the patient's thromboembolic risk is low.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Child; Choroid Hemorrhage; Contraindications; Female; Fibrinolytic Agents; Humans; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Risk Factors; Scleral Buckling; United Kingdom; Vitrectomy; Vitreous Hemorrhage; 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: Adult; Anticoagulants; Antifungal Agents; Candidiasis; Choroid Hemorrhage; Drug Interactions; Endophthalmitis; Eye Hemorrhage; Eye Infections, Fungal; Fluconazole; Humans; Male; Retinal Hemorrhage; Ultrasonography; Vitreous Hemorrhage; 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

To illustrate a case of peripheral retinal neovascularization (Eales disease) in a patient who tested positive for the factor V Leiden mutation.. A 42-year-old woman had a 1-week history of blurred vision in her right eye. Her medical history was remarkable for a cerebrovascular accident. Ophthalmoscopy of the right eye disclosed a mild vitreous hemorrhage and a ridge of retinal neovascularization in the temporal periphery. The left fundus showed evidence of temporal retinal ischemia. A laboratory evaluation for hypercoagulability was positive for factor V Leiden mutation.. Peripheral scatter laser photocoagulation was applied to the ischemic retina, and the neovascularization regressed. The patient began taking warfarin sodium to prevent further thrombotic events.. A laboratory evaluation for coagulopathy, including the factor V Leiden mutation, should be added to the examination of patients with Eales disease, especially individuals with a history of a previous thrombotic event.

Topics: Adult; Anticoagulants; Factor V; Female; Fluorescein Angiography; Fundus Oculi; Humans; Ischemia; Laser Coagulation; Mutation; Retinal Neovascularization; Retinal Vessels; Vasculitis; Vitreous Hemorrhage; Warfarin

An infant with severe homozygous protein C deficiency was brought to medical attention because of purpura fulminans and severe bilateral vitreous hemorrhages in the neonatal period. Infusions of fresh frozen plasma were given for 8 months. On two occasions, attempts to decrease the frequency of fresh frozen plasma infusions to less than twice a day led to episodes of microangiopathic hemolysis, fibrinolysis, and acute renal failure. Infarction of skin and subcutaneous tissues did not recur. Both episodes were controlled after reinstitution of fresh frozen plasma. Complications of therapy with fresh frozen plasma included hyperproteinemia and hypertension. Warfarin therapy was instituted when the baby was 8 months of age, followed by a gradual withdrawal of fresh frozen plasma therapy. The dose of warfarin required to maintain the prothrombin time in a range of 1.8 to 2.2 times normal varied considerably during short periods, a phenomenon that may have been due to several factors: hypercatabolism of the drug with prolonged administration, abnormality of liver function, variation in levels of serum albumin, fluctuations in drug dosage secondary to oral administration, and variations in dietary vitamin K. Protein C determinations by immunologic and functional assays consistently showed detectable but reduced protein C antigen levels with undetectable activity levels, suggesting that a dysproteinemia rather than a deficiency of synthesis is responsible for the child's coagulopathy.

Topics: Blood Coagulation Disorders; Hemolytic-Uremic Syndrome; Homozygote; Humans; Infant, Newborn; Isoantigens; Male; Plasma; Protein C; Protein C Deficiency; Purpura; Vitreous Hemorrhage; Warfarin