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EPIDEMIOLOGY OF THE ASSOCIATION BETWEEN ANTICOAGULANTS AND INTRAOCULAR HEMORRHAGE IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Kiernan, Daniel F MD*; Hariprasad, Seenu M MD; Rusu, Irene M BA; Mehta, Sahil V BS; Mieler, William F MD*; Jager, Rama D MD, MBA, FACS†‡

doi: 10.1097/IAE.0b013e3181e2266d
Original Study

Purpose: To determine the cumulative incidence and annual incidence of intraocular hemorrhage (subretinal hemorrhage or vitreous hemorrhage) in patients with neovascular age-related macular degeneration (AMD) and association with daily antiplatelet or anticoagulant (AP/AC) medication usage (aspirin, clopidogrel, and warfarin), age, gender, hypertension, diabetes mellitus, or bilateral neovascular AMD.

Methods: Retrospective cross-sectional study in a tertiary university setting. Data on 195 eyes of 195 patients without previous intraocular hemorrhage examined over 73 months were reviewed.

Results: Ninety-six of 195 patients (49.2%) were taking daily AP/ACs. Of patients taking daily AP/AC agents, 63.5% had hemorrhage compared with 29.2% of patients not taking (odds ratio = 4.21; 95% confidence interval = 1.42-8.46; P < 0.001). The overall annual incidence of intraocular hemorrhage was 0.14% per year. Among patients taking daily AP/AC, the cumulative incidence (61 of 96, 63.5%) and annual incidence (0.10%) of concurrent intraocular hemorrhage were significantly greater compared with patients not taking them (29 of 99, 29.2% and 0.04%, respectively; P < 0.0001). Fourteen of 18 patients (77%) taking more than 1 daily AP/AC had occurrence of intraocular hemorrhage. Antiplatelet or anticoagulant usage was an independent risk factor for the development of intraocular hemorrhage. The use of any agent resulted in a significantly increased risk of developing intraocular hemorrhage. Additionally, presence of bilateral neovascular AMD was a significant association in those taking daily AP/ACs, whereas age was a significant association in those not taking daily AP/AC agents.

Conclusion: All three daily AP/AC types were significantly associated with an increased risk of the development intraocular hemorrhage in patients with neovascular AMD, whereas gender, hypertension, and diabetes were not. Age was not significantly associated with hemorrhage in patients taking daily AP/AC agents, whereas the presence of bilateral neovascular AMD was significantly associated with hemorrhage. These findings indicate that the AP/AC use may predispose patients with neovascular AMD to intraocular hemorrhage more so than age and duration of disease alone. While the risk that discontinuing these medicines would pose to the patients' health may be too great to justify, ensuring that an appropriate medication dosage is maintained should be a priority within this patient population.

All three daily AP/AC types were significantly associated with an increased risk of the development of intraocular hemorrhage in patients with neovascular AMD, whereas gender, hypertension, and diabetes were not. Age was not significantly associated with hemorrhage in patients taking daily AP/AC agents, whereas the presence of bilateral neovascular AMD was significantly associated with hemorrhage. These findings indicate that the AP/AC use may predispose patients with neovascular AMD to intraocular hemorrhage more so than age and duration of disease alone.

From the *Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois; †Section of Ophthalmology, Department of Surgery, University of Chicago Hospitals, Chicago, Illinois; and ‡University Retina & Macula Associates, P.C., Oak Forest, Illinois.

Supported by Research to Prevent Blindness.

Presented at the 2009 Combined Meeting of the Retina Society, Macula Society and the American Society of Retina Specialists; New York, New York.

The authors have no financial, commercial, or propriety interest in any of the products mentioned in this article.

Reprint requests: Rama D. Jager, MD, MBA, FACS, University Retina & Macula Associates, P.C., 6320 W. 159th Street, Suite A, Oak Forest, IL 60452; e-mail: rjager@uretina.com

© The Ophthalmic Communications Society, Inc.