• Risk of Intraocular Bleeding With Novel Antithrombotics

    Written By: Lynda Seminara
    Selected By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, February 2018

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    Novel oral anticoagulation and anti­platelet therapies have become popular in the treatment of thromboembolic disease, but their ocular safety profiles are uncertain. Uyhazi et al. compared the risk of intraocular hemorrhage be­tween novel and traditional antithrom­botic agents and found that bleeding rates were no worse with the newer medications.

    For their retrospective study, the authors utilized a large national in­surance claims database to generate 2 parallel analyses. First, incident use of dabigatran etexilate or rivaroxaban was compared with incident use of warfarin sodium. For the second analysis, new use of prasugrel hydrochloride was compared with new use of clopidogrel bisulfate. Patients with previous intra­ocular hemorrhage or a prescription for the comparator drug were excluded from the study. The main outcome measure was the incidence of intraocu­lar hemorrhage within 90 days and 365 days. Multivariate regression models were applied to compare hazard ratios for developing intraocular hemorrhage.

    Data were compared for 146,137 patients who took warfarin (mean age, 69.8 years) and 64,291 patients who took dabigatran or rivaroxaban (mean age, 67.6 years) The hazard ratio for hemorrhage development was lower with dabigatran or rivaroxaban versus warfarin at 365 days (0.75) but not at 90 days (0.73). Data for the 103,796 patients taking clopidogrel (mean age, 68.0 years) and the 8,386 patients tak­ing prasugrel (mean age, 61.0 years) did not show a greater risk of intraocular hemorrhage with prasugrel at either 90 or 365 days.

    The authors emphasized that the growing use of novel antithrombot­ics for coronary conditions requires greater understanding of ocular safety profiles. Their findings suggest that the risk of intraocular hemorrhage is lower with dabigatran etexilate and rivaroxaban than with warfarin and is similar for prasugrel hydrochloride and clopidogrel bisulfate. Additional studies are needed to fully characterize the ocular safety profiles of the new antithrombotic agents. (Also see related commentary by Daniel Caldeira, MD, PhD, in the same issue.)

    The original article can be found here.