RETINAL HAEMORRHAGE

Antiplatelet or anticoagulant drug therapy does not appear to be related to the presence or size of retinal haemorrhage in patients with neovascular age-related macular degeneration (nAMD), new analyses of data collected in the Comparisons of AMD Treatment Trials (CATT) suggest.

Speaking on behalf of the CATT Research Group, Gui-Shuang Ying PhD told a session of the 2015 annual meeting of the Association for Research in Vision and Ophthalmology in Denver, USA, that patients with nAMD should continue taking antiplatelet/anticoagulant drugs as indicated for systemic medical conditions.

“Antiplatelet and anticoagulant drugs are commonly used in older persons to manage cardiovascular disease, and their use is associated with an increased risk of bleeding. Several studies have evaluated the association between antiplatelet/anticoagulant drugs and ocular haemorrhage, but their results are conflicting and inconclusive,” said Dr Ying, Associate Professor of Ophthalmology, and Senior Biostatistician, Centre for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, USA.

LARGEST STUDY

Now, with data analysed for 1,165 patients, CATT is the largest study to evaluate the association of antiplatelet/anticoagulant drug use with retinal haemorrhage. Patients who were eligible for CATT had untreated, active nAMD on optical coherence tomography (OCT), leakage on fluorescein angiography, and no vitreous haemorrhage or diabetic retinopathy that might require intervention during two years of follow-up.

Retinal haemorrhage associated with the choroidal neovascular (CNV) lesion was identified in the participants’ study eye by masked, certified readers using standardised grading of colour fundus photographs taken at baseline and after one and two years. Retinal haemorrhage included intraretinal, subretinal or sub-RPE bleeding, and was graded both for presence and size using four categories (none, ≤1, 1−2, and >2 disc areas).

At baseline, 608 patients (52 per cent) were using antiplatelet and/or anticoagulant drugs, and 724 patients (62 per cent) had a retinal haemorrhage. Rates of retinal haemorrhage were not significantly different among users of antiplatelet/anticoagulant drugs and non-users (64.5 per cent vs 59.6 per cent, p=0.09) or when comparisons were made between users and non-users considering only anticoagulants, only antiplatelets, or specific drugs.

In a logistic regression analysis adjusting for age, gender, smoking status, diabetes, cardiovascular disease and CNV bilaterality, there was no association between antiplatelet/anticoagulant drug use and retinal haemorrhage (odds ratio = 1.18, p=0.21).

Medication dose or duration of use also did not matter – there were no associations between antiplatelet/anticoagulant drug use and retinal haemorrhage even among patients who took higher doses or had more than 10 years of use.

Gui-Shuang Ying: gsying@mail.med.upenn.edu