Anticoagulant and Antiplatelet Use Increases Hemorrhage Risk in Exudative AMD: JAMA
A new study published in the Journal of American Medical Association found that patients with exudative age-related macular degeneration (AMD) using anticoagulants or antiplatelets faced a higher risk of intraocular hemorrhage requiring vitrectomy. Further the risk was greatest with combined therapy, and higher adherence further increased odds of hemorrhage.
The study used data from the Korean Health Insurance Review and Assessment Service and examined records of 1,49,620 patients aged over 40 with exudative AMD from May 2014 to 2023. Of these, nearly 95,000 patients were included in the cohort analysis, while more than 8,000 were assessed in a case-control design. This study aimed to determine whether blood-thinning medications contribute to vision-threatening complications in this already vulnerable group.
Analysis revealed that patients taking either anticoagulants or antiplatelets faced a significantly higher risk of developing intraocular hemorrhage severe enough to require vitrectomy, to remove blood from the eye.
In statistical terms, patients exposed to these drugs had a 15% higher hazard of such bleeding when compared to non-users. Anticoagulant users had an 88% higher likelihood of intraocular hemorrhage and antiplatelet users had a 37% higher risk. The patients taking both anticoagulants and antiplatelets simultaneously faced more than double the risk (128% higher) when compared to the individuals not on such medications.
The study also found individuals with higher adherence to their prescriptions were at greater risk of developing these hemorrhages. This suggests that consistent long-term use, while beneficial for cardiovascular protection, could increase the chance of vision-threatening complications in patients with AMD. AMD is a leading cause of vision loss among older adults worldwide, and exudative AMD in particular is prone to bleeding due to fragile abnormal blood vessels in the retina.
Overall, customized monitoring strategies may be required to balance cardiovascular benefits with ocular safety. This could mean more frequent retinal examinations or a careful reassessment of drug regimens for patients at high risk of eye bleeding. While anticoagulants and antiplatelets remain lifesaving medications for many cardiovascular patients, this research illuminates that their use in individuals with exudative AMD requires special caution.
Source:
Kim, M. S., Nam, S., Lee, J., & Woo, S. J. (2025). Antithrombotic medications and intraocular hemorrhage risk in exudative age-related macular degeneration. JAMA Network Open, 8(9), e2531366. https://doi.org/10.1001/jamanetworkopen.2025.31366
