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Antithrombotic Medication and the Risk of Vitreous Hemorrhage in Atrial Fibrillation: Korean National Health Insurance Service National Cohort

 Ko Eun Kim  ;  Pil-Sung Yang  ;  Eunsun Jang  ;  Sungjin Kim  ;  Boyoung Joung 
 YONSEI MEDICAL JOURNAL, Vol.60(1) : 65-72, 2019 
Journal Title
Issue Date
Aged ; Anticoagulants/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy* ; Cohort Studies ; Female ; Fibrinolytic Agents/therapeutic use* ; Humans ; Male ; Middle Aged ; National Health Programs* ; Platelet Aggregation Inhibitors/therapeutic use ; Propensity Score ; Proportional Hazards Models ; Republic of Korea ; Risk Factors ; Treatment Outcome ; Vitreous Hemorrhage/complications ; Vitreous Hemorrhage/drug therapy* ; Warfarin/therapeutic use
Vitreous hemorrhage ; anticoagulant ; antiplatelet ; atrial fibrillation
Purpose: Antithrombotic therapy could be related with nuisance bleeding. This study investigated whether vitreous hemorrhage (VH) is associated with specific types of antithrombotic medication in patients with atrial fibrillation (AF). Materials and Methods: In the Korean National Health Insurance Service National Sample Cohort, we identified 9352 antiplatelet/ anticoagulant-treated AF patients. The occurrence of VH was compared between warfarin (n=1493) and a propensity score (PS)matched antiplatelet group (n=1493) and between warfarin (n=1493) and a PS-matched warfarin+antiplatelet group (n=1493). Results: The outcomes of VH were lower in the warfarin than in the matched antiplatelet (1.45 vs. 3.72 events/1000 patient-years) and matched warfarin+antiplatelet groups (1.45 vs. 6.87 events/1000 patient-years). Compared with warfarin, the risk of VH increased with antiplatelet [adjusted hazard ratio (aHR) 3.90; 95% confidence interval (CI) 1.22–12.4, p=0.022] and warfarin+antiplatelet agents (aHR 4.39, 95% CI 1.74–11.2, p=0.002). Compared with warfarin only, warfarin+antiplatelet agents increased the risk of VH in patients ≥65 years, regardless of gender and hypertension. The risk of VH was significantly higher with dual antiplatelet therapy (aHR: 5.02, 95% CI: 1.56–16.2, p=0.007) or in dual (aHR: 5.02, 95% CI: 1.74–14.5, p=0.003) or triple therapy using warfarin and antiplatelet agents than with warfarin monotherapy (aHR: 6.12, 95% CI: 1.76–21.3, p=0.004). Conclusion: Dual antiplatelet or triple therapy increased the risk of VH significantly, compared to warfarin monotherapy. Considering the low efficacy of preventing ischemic stroke and high risk of bleeding, dual or triple therapy using warfarin and antiplatelet agents should be avoided to prevent VH in AF patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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