Subretinal hemorrhages associated with age-related macular degeneration in patients receiving anticoagulation or antiplatelet therapy

Am J Ophthalmol. 2010 Feb;149(2):316-321.e1. doi: 10.1016/j.ajo.2009.08.033. Epub 2009 Nov 24.


Purpose: To evaluate the incidence of and risk factors for subretinal hemorrhages in age-related macular degeneration (AMD) patients on anticoagulation or antiplatelet therapy.

Design: Retrospective, observational case series.

Methods: We retrospectively reviewed the medical and photographic records of 71 consecutive patients who sought treatment at our institution with acute subretinal hemorrhages complicating age-related macular degeneration. The size of the subretinal hemorrhage was measured in standardized Macular Photocoagulation Study disc areas. Data on the use of medications and medical indications for anticoagulation and antiplatelet therapy were obtained.

Results: Overall, patients receiving antithrombotic therapy had a significantly larger subretinal hemorrhage size (mean, 9.71 disc areas) than patients not receiving anticoagulant or antiplatelet therapy (mean, 2.99 disc areas). Subgroup analysis revealed that both antiplatelet (P < .0001) and anticoagulant therapy (P = .003) were associated with a significantly larger bleeding size. Moreover, subgroup analysis among patients with arterial hypertension revealed that individuals receiving antithrombotic therapy had a statistically significantly larger hemorrhage size than hypertensive patients who did not receive anticoagulants or antiplatelet agents (P < .0001).

Conclusions: Our results indicate that anticoagulants and antiplatelet agents are strongly associated with the development of large subretinal hemorrhages in AMD patients. Moreover, arterial hypertension is a strong risk factor for large subretinal hemorrhages in AMD patients receiving anticoagulants or antiplatelet agents. Physicians should be aware of an increased risk of extensive subretinal hemorrhage in AMD patients when deciding on the initiation and duration of anticoagulant and antiplatelet therapy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticoagulants / adverse effects*
  • Cardiovascular Diseases / drug therapy
  • Female
  • Humans
  • Incidence
  • Macular Degeneration / drug therapy*
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / adverse effects*
  • Retinal Hemorrhage / chemically induced*
  • Retinal Hemorrhage / surgery
  • Retrospective Studies
  • Risk Factors
  • Visual Acuity / physiology
  • Vitrectomy
  • Vitreous Hemorrhage / chemically induced
  • Vitreous Hemorrhage / surgery


  • Anticoagulants
  • Platelet Aggregation Inhibitors