Abstract
Purpose :
Hypercoagulable states such as atrial fibrillation (afib) or venous thromboembolism (VTE) are risk factors for future development of retinal vein occlusion (RVO). Management of states with systemic anticoagulation is standard of care. While warfarin is efficacious, more novel direct oral anticoagulants (DOACs) have gained favor due to improved therapeutic reliability and outcomes. The risk of future RVO development with DOACs has yet to be investigated in a large US cohort. The purpose of this study is to compare the risk of future RVO development amongst patients being managed for hypercoagulable states with either warfarin or DOACs.
Methods :
The TriNetX U.S. Collaborative Network, a HIPAA-compliant, large national database based in ICD-10 coding, was queried for patients with afib or VTE being managed with either warfarin or DOACs. The propensity score matching function in TriNetX was used to perform 1:1 matching based on age, sex, race, and vascular risk factors to create comparable groups managed with either DOAC or warfarin. Patients were matched at the time of anticoagulation initiation. Risk ratios for RVO development in patients without a prior diagnosis of RVO were calculated using TriNetx.
Results :
The TriNetX national database created two matched cohorts of 110,370 patients managed with warfarin and DOACs. At baseline, patients were an average of 73 years old, 71% Caucasian, 5% hispanic, and 52% female. Patients managed with warfarin were found to be at significantly increased risk of developing a new diagnosis of all RVO (RR 1.47, p<0.001), central RVO (RR 1.37, p<0.001), branched, RVO (RR 1.43, p<0.001), vitreous hemorrhage (RR 1.83, p<0.001), retinal hemorrhage (RR 1.77, p<0.001) or hyphema (RR 1.76, p<0.001) compared to patients managed with DOACs.
Conclusions :
The current analysis is the first in US patient populations to compare therapeutic anticoagulation with DOACs and warfarin with respect to future development of retinal vascular disease and complications. These findings suggest DOACs are associated with significantly reduced retinal vascular pathology compared to warfarin. Further post hoc analysis of large-scale clinical trials is warranted to further examine these findings.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.