Combination anti-platelet therapy is also associated with sight loss due to spontaneous vitreous haemorrhage.
The experience of Hallas et al[1] in respect of serious upper GI
bleeding mirrors our own findings of spontaneous vitreous haemorrhage
associated with combination anti-platelet therapy[2]. In the last 3 years
we have increasingly encountered spontaneous vitreous haemorrhage and also
intra-operative haemorrhage during vitrectomy in patients on these agents
as their use increases. We have seen further cases since our case series
was submitted. In our experience the combination of clopidogrel and
aspirin is most commonly encountered in these cases, and it is interesting
that Hallas et al found this combination to be associated with the highest
risk of upper GI haemorrhage.
Patients presenting with spontaneous vitreous haemorrhage, whilst on
combination treatment present a particular challenge. Early vitrectomy for
spontaneous haemorrhage is advocated by many[3] to detect and treat
associated retinal breaks (which may otherwise progress to retinal
detachment), because undetected retinal detachment concealed by dense
vitreous haemorrhage is associated with a poor outcome. Yet uncontrollable
intra-operative bleeding can be encountered in patients on combined
agents. Reverting to aspirin monotherapy[4], in consultation with the
patient’s physicians, for the period of surgery may be an option, balanced
against the cardiovascular risk of doing so.
References:
1. Hallas J, Dall M, Andries A, Andersen BS, Aalykke C, Hansen JM,
Andersen M, Lassen AT
Use of single and combined antithrombotic therapy and risk of serious
upper gastrointestinal bleeding: population based case-control study. BMJ.
2006; 333: 726.
3. Sarrafizadeh R. Hassan TS. Ruby AJ. Williams GA. Garretson BR.
Capone A Jr. Trese MT. Margherio RR. Incidence of retinal detachment and
visual outcome in eyes presenting with posterior vitreous separation and
dense fundus-obscuring vitreous hemorrhage. Ophthalmology. 2001;108:2273-
8.
4. Narendran N, Williamson TH. The effects of aspirin and warfarin
therapy on haemorrhage in vitreoretinal surgery. Acta Ophthalmol Scand
2003;81:38–40.
Rapid Response:
Combination anti-platelet therapy is also associated with sight loss due to spontaneous vitreous haemorrhage.
The experience of Hallas et al[1] in respect of serious upper GI
bleeding mirrors our own findings of spontaneous vitreous haemorrhage
associated with combination anti-platelet therapy[2]. In the last 3 years
we have increasingly encountered spontaneous vitreous haemorrhage and also
intra-operative haemorrhage during vitrectomy in patients on these agents
as their use increases. We have seen further cases since our case series
was submitted. In our experience the combination of clopidogrel and
aspirin is most commonly encountered in these cases, and it is interesting
that Hallas et al found this combination to be associated with the highest
risk of upper GI haemorrhage.
Patients presenting with spontaneous vitreous haemorrhage, whilst on
combination treatment present a particular challenge. Early vitrectomy for
spontaneous haemorrhage is advocated by many[3] to detect and treat
associated retinal breaks (which may otherwise progress to retinal
detachment), because undetected retinal detachment concealed by dense
vitreous haemorrhage is associated with a poor outcome. Yet uncontrollable
intra-operative bleeding can be encountered in patients on combined
agents. Reverting to aspirin monotherapy[4], in consultation with the
patient’s physicians, for the period of surgery may be an option, balanced
against the cardiovascular risk of doing so.
References:
1. Hallas J, Dall M, Andries A, Andersen BS, Aalykke C, Hansen JM,
Andersen M, Lassen AT
Use of single and combined antithrombotic therapy and risk of serious
upper gastrointestinal bleeding: population based case-control study. BMJ.
2006; 333: 726.
2. Herbert EN, Mokete B, Williamson TH, Laidlaw DAH. Haemorrhagic
vitreoretinal complications associated combined antiplatelet agents. Br J
Ophthalmol. 2006;90:1209-10.
3. Sarrafizadeh R. Hassan TS. Ruby AJ. Williams GA. Garretson BR.
Capone A Jr. Trese MT. Margherio RR. Incidence of retinal detachment and
visual outcome in eyes presenting with posterior vitreous separation and
dense fundus-obscuring vitreous hemorrhage. Ophthalmology. 2001;108:2273-
8.
4. Narendran N, Williamson TH. The effects of aspirin and warfarin
therapy on haemorrhage in vitreoretinal surgery. Acta Ophthalmol Scand
2003;81:38–40.
Competing interests:
None declared
Competing interests: No competing interests