September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
The Incidence of Ocular Adverse Bleeding Events in Patients Utilizing Novel Oral Anticoagulant and Antiplatelet Therapy in Routine Clinical Practice
Author Affiliations & Notes
  • Dattanand M Sudarshana
    Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, United States
  • Eleni Konstantinou
    Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
  • Sruthi Arepalli
    Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, United States
  • Andrew Schachat
    Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, United States
  • Justis P Ehlers
    Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, United States
  • Rishi P Singh
    Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Dattanand Sudarshana, None; Eleni Konstantinou, None; Sruthi Arepalli, None; Andrew Schachat, None; Justis Ehlers, None; Rishi Singh, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1574. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to Subscribers Only
      Sign In or Create an Account ×
    • Get Citation

      Dattanand M Sudarshana, Eleni Konstantinou, Sruthi Arepalli, Andrew Schachat, Justis P Ehlers, Rishi P Singh; The Incidence of Ocular Adverse Bleeding Events in Patients Utilizing Novel Oral Anticoagulant and Antiplatelet Therapy in Routine Clinical Practice. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1574.

      Download citation file:


      © 2017 Association for Research in Vision and Ophthalmology.

      ×
  • Supplements
Abstract

Purpose : Due to the concomitant increase in new antithrombotic drugs and long-term antithrombotic therapy, there is a need for ophthalmologists to gain a working knowledge of the adverse risks associated with these medications. However, previous literature assessing bleeding complications of these drugs in an ophthalmology setting is scarce. Thus, we seek to evaluate the incidence of spontaneous ocular bleeding events associated with novel anticoagulation/antiplatelet therapy.

Methods : An IRB approved retrospective study was performed to identify all patients that have presented to the Cole Eye Institute taking novel anticoagulants (Rivaroxaban, Bivalirudin, Lepirudin, Dabigatran, Argatroban) and antiplatelet agents (Clopidogrel, Prasugrel, Ticagrelor). Ocular hemorrhagic events were identified by reviewing patient encounters and searching the medical record with key terms such as heme, hemorrhage, and bleeding. Hemorrhagic events were subdivided into subconjunctival, anterior chamber, vitreous, pre-retinal, intraretinal, subretinal/choroidal, and extraocular. Baseline demographics, relevant systemic and ocular comorbidities, reason for anticoagulation therapy and aspirin use were also noted.

Results : A total of 1829 patients (mean age: 74.4 yrs) with a history of novel anticoagulant/antiplatelet use were identified. 44 patients (2.4%) had spontaneous bleeding events during anticoagulation with 32 patients having a single episode and 12 patients having multiple episodes (≥2 bleeding events). Subconjunctival hemorrhage was the most common bleeding location (51%) followed by intraretinal (26%), subretinal/choroidal (11%), vitreous (9%), hyphema (2%) and extraocular (2%). Incidence of spontaneous bleeding on prasugrel (7.2%) and rivaroxaban (3.1%) was higher compared to dabigatran (1.9%), clopidogrel (2.0%), and ticagrelor (2.7%). Furthermore, 45% of the patients with spontaneous bleeding were also on aspirin.

Conclusions : Incidence of spontaneous ocular bleeding with the use of novel anticoagulant/antiplatelet agents is significantly higher than previously reported literature. Patients on anticoagulation/antiplatelet therapy should be carefully monitored for ocular bleeding, especially if they have associated systemic/ocular comorbidity.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×