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| |  Blood Thinners Increase Risk of Retinal Haemorrhage in Patients With Macular Degeneration: Presented at RC2009 By Cameron Johnston NEW YORK -- October 7, 2009 -- Patients with age-related macular degeneration (AMD) who are being treated with anticoagulant and antiplatelet drug such as aspirin, warfarin, and clopidogrel run a significant risk of retinal haemorrhage, according to a study presented here October 2 at the Retina Congress (RC) 2009. According to Daniel Kiernan MD, University of Illinois, Chicago, Illinois, each of these drugs is associated with an increased risk of haemorrhage. It is a cause for concern for ophthalmologists treating these patients because so many patients with AMD are elderly and are also being treated concomitantly for cardiovascular conditions for which antiplatelets and anticoagulants are a mainstay of therapy. Taking the patient off the blood-thinning agent is not an option for these patients and so clinicians have to be aware of the risk that these drugs can present for other areas of the body such as the eyes. Dr. Kiernan and colleagues looked at the records of 195 eyes in 195 patients, of whom 96 were taking antiplatelets and anticoagulants on a daily basis. These patients had a mean age of 83 years. Of the patients who were taking antiplatelets or anticoagulants, 80 (41%) were taking aspirin, 18 (9.2%) were taking clopidogrel, 16 (8.2%) were taking warfarin, and 18 (9.2%) were taking multiple drugs. All of the patients taking these drugs had hypertension, and 20 had diabetes as well. Of the patients taking either antiplatelets or anticoagulants, 63% developed retinal haemorrhage compared with 29% who were not taking these drugs, for an odds ratio (OR) of 4.21 (P < .001). Expressed as an annual incidence rate, this means 7.6 patients per 100 would develop retinal haemorrhage per year when taking these drugs. Although only a small number of patients were using multiple drugs, the odds ratio of developing retinal haemorrhage was highest among these patients (OR = 12.9). The odds ratio for patients taking aspirin and clopidogrel were 3.75 and 8.76, respectively. An interesting finding from this review was that patients who had bilateral wet AMD were more likely to have been taking antiplatelets/anticoagulants (OR = 3.47). Dr. Kiernan suggested that the constant thinning of the blood or inhibition of platelet factors, may in some way, contribute to the development of wet AMD, which then increases the risk of haemorrhages, although it is hard to prove cause-and-effect and this study was not intended to do so. Together these findings suggest that drugs that patients take for systemic conditions such as heart disease and hypertension may have an impact on their visual health as well, and that these patients will need to be followed more closely. In particular, he said, information about a patient’s use of antiplatelets and anticoagulants should be noted prominently on the patients’ charts. The 2009 Retina Congress is a combined meeting of the American Society of Retina Specialists, the Macula Society, and the Retina Society. [Presentation title: The Association of Antiplatelets and Anticoagulants With Intraocular Hemorrhage in Patients With Exudative Age-Related Macular Degeneration. Abstract 732]
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