Key result
Warfarin linked to ~95% higher risk of postoperative vitreous hemorrhage versus DOACs after glaucoma surgery.
Why the study?
To compare the risk of postoperative ocular hemorrhagic complications and reoperation in glaucoma surgery patients taking warfarin versus direct oral anticoagulants.
Does warfarin increase the risk of postoperative hemorrhagic complications compared to DOACs in adult patients undergoing glaucoma surgery?
Cohort (n=37,694)
Yes
Does warfarin increase the risk of postoperative hemorrhagic complications compared to DOACs in adult patients undergoing glaucoma surgery?
In patients undergoing glaucoma surgery, preoperative use of warfarin is associated with a significantly increased risk of various ocular hemorrhagic complications compared to DOACs, although neither increases the risk of requiring a secondary surgical intervention.
Answers are grounded in this paper and cite their sources.
Warfarin was associated with higher ocular hemorrhage risk after glaucoma surgery; leaves open whether DOACs should be preferred pending randomized data.
Purpose: To compare the risk of postoperative ocular hemorrhagic complications and reoperation in glaucoma surgery patients taking warfarin versus direct oral anticoagulants (DOACs). Patients and Methods: This retrospective cohort study used the TriNetX global federated health research network. We identified 15,336 glaucoma surgery patients on warfarin and 22,358 on DOACs between January 1, 2000 and January 1, 2025. After 1:1 propensity score matching for age, gender, race, Type 2 Diabetes, hypertension, hyperlipidemia, and nicotine dependence, 15,019 patients remained in each cohort. We analyzed postoperative hemorrhagic complications within 1 year, including vitreous, conjunctival, retinal, and choroidal hemorrhages; hyphema; mitomycin injection; and periocular hemorrhage. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated, with significance set at p < 0.05. A secondary analysis assessed reoperation risk among those who experienced hemorrhagic complications. Patients on anticoagulants were compared to glaucoma patients with hemorrhagic complications who were not on anticoagulants. Reoperations included repeat trabeculectomy and aqueous shunt revision/insertion. Results: Warfarin was associated with significantly higher risk of vitreous hemorrhage (RR 1.949, CI 1.563-2.321, p < 0.0001), conjunctival hemorrhage (RR 1.329, CI 1.007-1.710, p = 0.0459), retinal hemorrhage (RR 1.512, CI 1.145-1.997, p = 0.0033), and hyphema (RR 1.740, CI 1.240-2.462, p = 0.0015). No increased risk was found for choroidal hemorrhage or postoperative mitomycin C injection. Hemorrhagic complications did not increase reoperation risk in patients on anticoagulants compared to controls. Conclusion: Warfarin use is linked to higher ocular hemorrhagic complication rates post-glaucoma surgery compared to DOACs. Anticoagulants use did not increase the risk of reoperation.
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Ehsan et al. (2025) conducted a cohort in Glaucoma (n=37,694). Warfarin vs. Direct oral anticoagulants (DOACs) was evaluated on Vitreous hemorrhage (RR 1.949, 95% CI 1.563-2.431, p=<0.0001). Warfarin increased the risk of postoperative vitreous hemorrhage and other ocular hemorrhagic complications compared to DOACs in patients undergoing glaucoma surgery.
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