Oral Antithrombotic Medication Is Associated with Improved Visual Outcomes in Eyes with Submacular Hemorrhage from Wet Age-Related Macular Degeneration

Abstract

Purpose

To determine differences in visual acuity (VA) outcomes in eyes of patients on antithrombotics (antiplatelet agents and anticoagulants) that develop submacular hemorrhage (SMH) compared with eyes of patients who are not on antithrombotics and develop SMH.

Design

A retrospective study of patients presenting with fovea-involving SMH due to wet age-related macular degeneration over an 8-year period who had ≥6 months of follow-up.

Subjects

Demographics, VA at presentation and final follow-up after SMH management, and history of any antithrombotic therapy were collected. Patients were grouped based on whether they were on anticoagulants (direct oral anticoagulants or warfarin), antiplatelet agents (P2Y12 inhibitors, aspirin, or both), or neither.

Methods

Multivariate generalized estimating equations were used for statistical analysis.

Main Outcome Measures

The difference between VA at presentation with SMH and VA at final follow-up was compared between patients taking oral anticoagulants or antiplatelet agents and those not on any antithrombotic agent.

Results

Seventy-seven eyes of 74 patients were included. Twenty were on oral anticoagulants, 38 were on antiplatelet agents, and 22 were on neither. After controlling for age, sex, post-SMH cataract surgery, time to presentation, treatments received, initial VA, and follow-up duration, patients taking oral anticoagulants had greater improvement in VA at final follow-up compared with patients who were not taking a concurrent antithrombotic agent (P = 0.001); however, patients on oral antiplatelets did not (P = 0.09). After additionally controlling for the initial size and thickness of SMH, patients taking oral anticoagulants and patients taking oral antiplatelets had greater improvement in VA at final follow-up compared with patients who were not taking an antithrombotic (P = 0.002 and P < 0.001, respectively).

Conclusions

Patients taking oral anticoagulants who then develop an SMH may have better long-term VA outcomes than those who were not. However, this effect was not seen in patients taking oral antiplatelet medications. This suggests that baseline anticoagulants may be associated with improved VA outcomes in eyes that develop an SMH. When controlling for size and thickness of SMH, patients taking oral anticoagulants and those taking oral antiplatelets had better long-term VA outcomes than those who were not, suggesting a potential mitigating effect of oral antithrombotics.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.