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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.
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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.
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.
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.
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.
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