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A. G. Sharma, A. E. Allen, C. A. Ryan, C. A. Kiesel, T. Ghuman, P. A. Raskauskas, G. L. Wing, J. P. Walker; Study of Subretinal Hemorrhage in Patients on Anticoagulants With Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):76.
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To study the presence and size of subretinal hemorrhage (SRH) in patients with neovascular Age-Related Macular Degeneration (ARMD) who are on different anticoagulants.
A retrospective chart review of 486 consecutive patients with newly diagnosed neovascular ARMD from 2007-2008 was performed. Data such as age, gender, anticoagulation use, and details of treatment were collected. Patients were divided into the type of anticoagulation use. The categories included (1) aspirin alone, (2) plavix, (3) coumadin, and (4) no anticoagulant use. The presence of SRH on exam was studied and defined as SMALL if the area was less than one disc diameter in size or LARGE if greater than one disc diameter in size. Comparison was made between patients on anticoagulants versus patients not on any anticoagulants, as well as between patients on different anticoagulants.
Analysis was performed on 486 consecutive patients with neovascular ARMD. All patients were treated with anti-VEGF treatment (Lucentis or Avastin), laser, or photodynamic therapy. There were 306 patients (306/468 or 65%) taking anticoagulants. The average age of the patient in that group was 79 years and had a mean follow up of 14 months. There were 162 patients (162/486 or 35%) not on any anticoagulants. The average age of the patients in that group was 77 years with a mean follow up of 14 months. In patients in the anticoagulation group, 59% (181/306) of patients had evidence of small SRH and 9% (27/306) had large SRH. In patients on aspirin alone, 61% (139/228) had small SRH and 7% (16/228) had large SRH. In patients on plavix, 56% (18/32) had small SRH, and 3% (1/32) had large SRH. In patients on coumadin, 52% (24/46) had small SRH and 22% (10/46) had large SRH. In patients not on any anticoagulants, 53% (86/162) of patients had small SRH and 12% (19/162) had large SRH.
A significant number of patients who are at risk for neovascular ARMD are also on anticoagulants such as aspirin, plavix, or coumadin. Patients on anticoagulants have a similar incidence of SRH compared to patients not on any anticoagulants. Patients on coumadin have the highest incidence of large SRH, while patients on aspirin have the highest incidence of small SRH.
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