Abstract
Abstract
Background Spontaneous ocular haemorrhages under antithrombotic therapy are rare but can lead to persistent visual impairment up to blindness. Despite increasing prescriptions of antithrombotic medications, systematic overviews on incidence, risk factors, and management are lacking.
Patients and Methods Based on a selective literature review, current clinical studies, registry data, and epidemiologic analyses on spontaneous ocular haemorrhages under oral/parenteral anticoagulation and antiplatelet therapy were evaluated. The evidence was summarized regarding incidence, risk constellations, acute bleeding management, and therapy resumption.
Results The risk of ocular haemorrhages varies significantly depending on medication, comorbidity, and combination therapy. Elderly patients with arterial hypertension, impaired renal function, and pre-existing eye diseases are particularly at risk. Dual antiplatelet therapy and combinations of anticoagulants and antiplatelet agents significantly increase the risk. Among oral anticoagulants, apixaban shows the most favourable ocular bleeding profile. Acute management strategies range from systemic reversal (e.g., idarucizumab, andexanet alfa) to ophthalmologic interventions (laser, vitrectomy). Therapy resumption should be coordinated interdisciplinarily.
Conclusions Ocular haemorrhages under antithrombotic therapy require prompt, risk-adapted management. The choice of anticoagulant, control of modifiable risk factors, and clear decision algorithms for resumption of antithrombotic therapy are essential to prevent both vision loss and thromboembolic complications.