Blood thinners in patients with submacular hemorrhage secondary to neovascular AMD

Abstract

Purpose : Patients with extensive submacular hemorrhage (SMH) secondary to age-related macular degeneration (AMD) have a poor visual prognosis despite surgical intervention. Systemic blood-thinning drugs which are commonly prescribed in the same age group are known to increase the overall risk of severe hemorrhage in many parts of the body. This study aimed to investigate whether systemic blood-thinning drugs have an impact on the severity of SMH and if there are differences between the different types of blood-thinning medication.

Methods : Medical records of patients who suffered from surgically treated SMH between 2019 and 2022 were reviewed. All charts were reviewed and patients interviewed or called if data was missing. We documented all results from clinical and OCT examinations and analyzed OCT images and or color fundus photorgraphy if present regarding hemorrhage size. We recorded if patients were taking oral blood thinners or suffered from arterial hypertension as well as other systemic conditions. Data was collected using Microsoft Excel spreadsheets and was analyzed using SPSS statistics.

Results : 175 patients with a mean age of 83 years were included in this retrospective analysis. 128 patients (73.4%) were on blood-thinning therapy. The mean size of SMH was 33.62 mm². Mean BCVA at initial presentation was 1.58 logMAR and 1.47 logMAR one year after surgery. The size of SMH was significantly larger in patients on blood-thinning medication (36.03 mm² vs. 21.73 mm²) (p=0.001) and their BCVA postoperatively was worse with 1.63 logMAR compared to 1.32 logMAR after 1 year (p=0.49). Patients with Vitamin-K antagonists had larger SMH size and worse outcomes regarding BCVA compared to direct oral anticoagulants.

Conclusions : Blood thinners in patients with AMD affect the severity of SMH. As a consequence, the indication for their intake should be critically evaluated.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.