Incidence of hemorrhagic complications after intravitreal bevacizumab (avastin) or ranibizumab (lucentis) injections on systemically anticoagulated patients.

Abstract

PURPOSE:

To assess the risk of hemorrhagic complications when performing intravitreal injections on systemically anticoagulated patients.

METHODS:

A single-center retrospective case series of 520 consecutive patients (675 eyes) receiving 3,106 antivascular endothelial growth factor injections. Patients on the systemic anticoagulants Coumadin (warfarin sodium) or Plavix (clopidogrel bisulfate) were identified, as well as patients on aspirin. Demographic parameters were recorded, as well as relevant anticoagulant medications, preoperative/postoperative best-corrected visual acuities and intraocular pressures, previous ocular surgery, relative ocular diagnoses, and injection complications.

RESULTS:

Of all patients, 104 were on Coumadin (134 eyes; 548 injections), 90 were on Plavix (123 eyes; 523 injections), 7 were on both Coumadin and Plavix (8 eyes; 33 injections), and 319 were not anticoagulated (400 eyes; 2002 injections). Also, 1,254 injections were on patients taking aspirin. There were no hemorrhagic complications (choroidal hemorrhage, vitreous hemorrhage, or increased submacular hemorrhage) noted in the Plavix (P = 1.0000; 95% confidence interval = 0.0000-0.0088), Coumadin (P = 1.0000; 95% confidence interval = 0.0000-0.0084), or aspirin (P = 1.0000; 95% confidence interval = 0.0000-0.0037) groups.

CONCLUSION:

The risk of hemorrhagic complications in systemically anticoagulated patients receiving intravitreal injections is extremely low. Because of the demonstrated thromboembolic risk of stopping anticoagulant therapy, we recommend that patients continue their current regiment without cessation.

• Authors: John O Mason 3rd, Paul A Frederick, Michael G Neimkin, Milton F White Jr, Richard M Feist, Martin L Thomley, Michael A Albert Jr
• Journal: Retina (Philadelphia, Pa.) (Retina) Vol. 30 Issue 9 Pg. 1386-9 (Oct 2010) ISSN: 1539-2864 [Electronic] United States
• PMID: 20924260 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Anticoagulants
• Platelet Aggregation Inhibitors
• VEGFA protein, human
• Vascular Endothelial Growth Factor A
• Bevacizumab
• Warfarin
• Clopidogrel
• Ticlopidine
• Aspirin
• Ranibizumab

Topics

• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors (administration & dosage)
• Antibodies, Monoclonal (administration & dosage)
• Antibodies, Monoclonal, Humanized
• Anticoagulants (administration & dosage)
• Aspirin (administration & dosage)
• Bevacizumab
• Choroidal Neovascularization (drug therapy)
• Clopidogrel
• Eye Hemorrhage (epidemiology, etiology)
• Female
• Humans
• Incidence
• Intravitreal Injections
• Macular Degeneration (drug therapy)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (administration & dosage)
• Ranibizumab
• Retrospective Studies
• Risk Factors
• Ticlopidine (administration & dosage, analogs & derivatives)
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Warfarin (administration & dosage)