Kim Min Seok, Nam Seonghee, Lee Jeongwoo, Woo Se Joon
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Samil Pharm Co Ltd, Seoul, Korea.
JAMA Netw Open. 2025 Sep 2;8(9):e2531366. doi: 10.1001/jamanetworkopen.2025.31366.
Although the use of anticoagulants or antiplatelets is known to increase bleeding risk, there is limited evidence on whether they contribute to a higher incidence of intraocular hemorrhage in patients with age-related macular degeneration (AMD).
To examine the association between anticoagulant or antiplatelet use and clinically important intraocular hemorrhage requiring vitrectomy in patients with exudative AMD.
DESIGN, SETTING, AND PARTICIPANTS: In this nationwide, population-based, retrospective cohort study using the Korean Health Insurance Review and Assessment Service database, 149 620 patients with exudative AMD older than 40 years were identified from May 1, 2014, to April 30, 2023.
Use of anticoagulants or antiplatelets.
The main study outcome was clinically important intraocular hemorrhage requiring vitrectomy. The analysis used a retrospective, longitudinal cohort study design using Cox proportional hazards regression analysis and Kaplan-Meier survival analyses (exposure vs nonexposure group) and a cross-sectional case-control study design using logistic regression analysis (hemorrhage vs no hemorrhage group). All analyses were adjusted for demographics and comorbidities.
A total of 94 449 patients (mean [SD] age, 71.8 [9.8] years; 55 677 [59.0%] male) were included in the cohort study, and 8110 patients (mean [SD] age, 70.2 [9.6] years; 5090 [62.8%] male) were included in the case-control study. In the Cox proportional hazards regression analysis, anticoagulant or antiplatelet exposure was associated with a higher risk of intraocular hemorrhage requiring vitrectomy (adjusted hazard ratio, 1.15; 95% CI, 1.02-1.29). The incidence probability of intraocular hemorrhage requiring vitrectomy was higher in the exposure group than the nonexposure group. In the logistic analysis, the use of anticoagulants (adjusted odds ratio [aOR], 1.88; 95% CI, 1.45-2.44) or antiplatelets (aOR, 1.37; 95% CI, 1.19-1.57) was associated with intraocular hemorrhage requiring vitrectomy. The combined use of anticoagulants and antiplatelets showed the highest aOR (aOR, 2.28; 95% CI, 1.65-3.15). Higher medication adherence was also associated with a higher aOR of intraocular hemorrhage (aOR, 1.69; 95% CI, 1.45-1.97).
In this nationwide cohort study of patients with exudative AMD, antithrombotic medications were associated with a higher risk of intraocular hemorrhage requiring vitrectomy. These results suggest the need for proactive communication and tailored monitoring strategies to help minimize such sight-threatening complications.
尽管已知使用抗凝剂或抗血小板药物会增加出血风险，但关于它们是否会导致年龄相关性黄斑变性（AMD）患者眼内出血发生率升高的证据有限。
研究抗凝剂或抗血小板药物的使用与渗出性AMD患者需要进行玻璃体切除术的具有临床重要意义的眼内出血之间的关联。
设计、设置和参与者：在这项基于全国人群的回顾性队列研究中，使用韩国健康保险审查和评估服务数据库，从2014年5月1日至2023年4月30日识别出149620例年龄超过40岁的渗出性AMD患者。
使用抗凝剂或抗血小板药物。
主要研究结局是需要进行玻璃体切除术的具有临床重要意义的眼内出血。分析采用回顾性纵向队列研究设计，使用Cox比例风险回归分析和Kaplan-Meier生存分析（暴露组与非暴露组），以及采用逻辑回归分析的横断面病例对照研究设计（出血组与无出血组）。所有分析均针对人口统计学和合并症进行了调整。
队列研究共纳入94449例患者（平均[标准差]年龄，71.8[9.8]岁；55677例[59.0%]为男性），病例对照研究纳入8110例患者（平均[标准差]年龄，70.2[9.6]岁；5090例[62.8%]为男性）。在Cox比例风险回归分析中，抗凝剂或抗血小板药物暴露与需要进行玻璃体切除术的眼内出血风险较高相关（调整后风险比，1.15；95%置信区间，1.02 - 1.29）。需要进行玻璃体切除术的眼内出血的发病概率在暴露组高于非暴露组。在逻辑分析中，使用抗凝剂（调整后比值比[aOR]，1.88；95%置信区间，1.45 - 2.44）或抗血小板药物（aOR，1.37；95%置信区间，1.19 - 1.57）与需要进行玻璃体切除术的眼内出血相关。抗凝剂和抗血小板药物联合使用显示出最高的aOR（aOR，2.28；95%置信区间，1.65 - 3.15）。更高的药物依从性也与眼内出血的更高aOR相关（aOR，1.69；95%置信区间，1.45 - 1.97）。
在这项针对渗出性AMD患者的全国性队列研究中，抗血栓药物与需要进行玻璃体切除术的眼内出血风险较高相关。这些结果表明需要进行积极沟通和制定针对性的监测策略，以帮助尽量减少此类威胁视力的并发症。
Zotero 插件