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R.N. Frank, M. Jancevski; Anticoagulant Drugs Do Not Increase the Risk of Vitreous Hemorrhage in Proliferative Diabetic Retinopathy or Retinal Vein Occlusions . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4794.
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Purpose: The Early Treatment Diabetic Retinopathy Study(ETDRS) demonstrated that aspirin does not increase the risk of vitreous hemorrhage (VH) in diabetic retinopathy. We asked whether other drugs with anticoagulant properties increase the risk of vitreous hemorrhage in subjects with proliferative diabetic retinopathy (PDR), or with central (CVO) or branch (BVO) retinal vein occlusions. Methods: We examined records of all 1,877 patients seen at the Kresge Eye Institute from 1999 through 2003 with the diagnosis of PDR (n = 1,370), CVO (n = 262), or BVO (n = 245). We noted whether they had VH, and their medications, either at the time of presentation with their initial hemorrhage, or (if no hemorrhage) at their most recent clinic visit. Using contingency table analysis, we calculated whether aspirin or other drugs with anticoagulant properties (warfarin, clopidogrel, non–steroidal anti–inflammatory agents or cyclooxygenase–2 inhibitors) were significantly associated with the occurrence of VH. Secondarily, we examined whether any antihypertensive agents were associated with VH. Results: The prevalence of VH in patients with PDR on aspirin (231 with VH, 231 without) was less than the prevalence of VH in PDR patients not using aspirin (540 with VH, 368 without; p = 0.0202), different from ETDRS results. Warfarin did not increase the occurrence of VH in PDR (36 with VH, 33 without; in patients not on warfarin, 735 with VH, 566 without, p = 0.536). Other anticoagulant drugs also did not increase VH in PDR. No antihypertensive drug significantly increased, or decreased, the occurrence of VH in PDR. Neither anticoagulant nor antihypertensive drugs significantly altered the occurrence of VH in CVO or BVO. Conclusions: Our data indicate that neither aspirin nor other commonly used drugs with anticoagulant properties, nor any anti–hypertensive drugs, increase the risk of VH in patients with PDR, BVO, or CVO. However, that aspirin is associated with a reduction of VH in PDR in this retrospective, non–randomized survey is contrary to ETDRS findings.
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