Antiplatelet and anticoagulant drugs do not affect visual outcome in neovascular age-related macular degeneration in the BRAMD trial

PURPOSE: To determine if use of antiplatelet or anticoagulant (AP/AC) medication influences visual acuity in patients with active neovascular age-related macular degeneration (N-AMD).

DESIGN: Retrospective analysis of data from a randomized controlled trial METHODS: Setting: Multi-center STUDY POPULATION: 330 patients with active N-AMD from the BRAMD study, a comparative trial between bevacizumab and ranibizumab in the Netherlands.

OBSERVATION PROCEDURES: Patients underwent an extensive ophthalmic examination. Visual acuity was categorized into functional vision (best corrected visual acuity (BCVA) >=0.5), visual impairment (BCVA < 0.5), and severe visual impairment (BCVA<0.3). Fundus photographs were graded for presence of retinal or subretinal hemorrhages. Information on AP/AC medication was obtained through interview. Logistic regression analysis was used to determine associations between AP/AC medication and outcomes. Frequency of hemorrhages in users and non-users stratified for visual acuity categories was analyzed with ANCOVA.

MAIN OUTCOME MEASURES: BCVA and presence of hemorrhages.

RESULTS: In total, 40.9% of the patients used AP/AC medication, of which 73.3% was aspirin. AP/AC use was not associated with visual impairment (adjusted odds ratio (OR) 0.79 (95% confidence interval (CI) 0.43-1.44), or severe visual impairment (adjusted OR 0.75 (95% CI 0.40-1.43). Patients on AP/AC presented with comparable frequencies of hemorrhages (27% versus 32%, P=0.29, respectively). Similar results were found when analyses were restricted to aspirin users only.

CONCLUSION: In our study, use of AP/AC medication was neither associated with visual decline nor with the occurrence of hemorrhages in patients with active N-AMD.