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D. F. Kiernan, S. M. Hariprasad, R. Singh, R. D. Jager, W. F. Mieler; The Association of Daily Anticoagulant Use and Intraocular Hemorrhage in Patients With Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3499.
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To compare the occurrence of subretinal (SRH) and vitreous hemorrhage (VH) in patients with exudative age-related macular degeneration (wet AMD) taking daily aspirin, clopidogrel (PlavixTM) and/or warfarin compared to patients with wet AMD not on daily anticoagulant medications.
Retrospective analysis. Patients were excluded if they had a history of posterior segment surgery or retinal or choroidal neovascularization in the study eye not related to wet AMD.
Average follow-up was 27.1 months. 59% of patients taking daily anticoagulants (n=103) had subretinal hemorrhage compared to 29% of patients not on anticoagulants (n=102). (Odds ratio [OR]=3.48; p=1.02 x 10-5) 5.8% of patients on anticoagulants had vitreous hemorrhage compared to 0.98% of controls. (OR=6.02; p=0.029) 77% of patients taking more than one daily anticoagulant (n=15) had at least one type of hemorrhage occur within the follow-up period. Among individual anticoagulants, aspirin use was most significantly associated with SRH, (OR=3.26; p=1.32 x 10-4) although it was also statistically significant for clopidogrel and warfarin. (OR=6.0 and 10.4, p=0.025 and 0.014 respectively.) Only warfarin demonstrated statistically significant association with VH, (OR=23.3; p=0.04) though aspirin trended toward significance. (OR=4.98, p=0.09) SRH in patients taking daily anticoagulants tended to be larger, take longer to resolve and have a more detrimental effect on visual acuity than SRH in patients not on daily anticoagulants.
Daily anticoagulant use may predispose to increased occurrence of SRH and VH in patients with wet AMD with resultant sudden and severe visual loss. Aspirin, the most commonly used daily anti-platelet agent, showed the strongest association with intraretinal hemorrhage, though all three anticoagulant types were significantly associated with increased incidence of intraretinal hemorrhage, vitreous hemorrhage or both.
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