Could anticoagulants contribute to Macular Degeneration / blindness?

[LubDubLubDub]

Even my heart surgeon couldn't answer this one.

I'm 55. In Oct 2009 I needed my Mitral valve replaced. I was faced with the choice of a tissue valve (they wear out, but no Coumadin) or a mechanical (ticking forever, but Coumadin forever).

The mechanical route seemed like a no-brainer... but it suddenly dawned on me that my 80+ year old mother has fought blindness for 20 years due to "wet" Macular Degeneration (bleeding in the retina). Mom having this disease means that I'm a 50% heredity risk of getting it myself.

Since anticoagulants reduce clotting - couldn't that contribute to retinal bleeding?

Suddenly Coumadin didn't seem like such a good idea for me. My heart doc had never been asked that question, and didn't really have a good answer, but thought it was certainly another check mark in the Negative Column for anticoagulants.

Yep, I went with the tissue valve - a Medtronic Mosaic Porcine valve. Oink.

Anyone have any solid info on this topic? (Certainly if you have a history of MD, do some research before flirting with potential blindness.)

 

[LubDubLubDub]

Well, I'm about to answer my own question!

I just did some online research on a few Macular Degeneration forums like this one. Here was a pretty definitive answer in one that I found, written by an MD:

>> We received the following question from a reader: “Can you inform me if there are any studies indicating a connection [or lack of one] between Macular Degeneration and cardiac ‘blood thinners?’”

Answer: This is a good question. While there is no evidence that aspirin, any other platelet inhibitor, or Coumadin® increases the progression of AMD, there is A LOT OF EVIDENCE however that Coumadin® increases the risk of severe bleeding in eyes of patients with the wet or neovascular form of AMD. The bleeding CAN BE SO SEVERE THAT ALL VISION IS LOST. Therefore, if you have the wet form of AMD, you should ask your doctor if you really need Coumadin®. Your doctor may or may not be able to take you off the drug, if for instance, you have an artificial heart valve, atrial fibrillation, or a history of strokes. If this is the case, then ask your doctor to keep the dose and the INR (a measure of how much you are anticoagulated) as low as possible. One would think that aspirin or other platelet inhibitors would also increase the risk of bleeding in AMD but that hasn’t seemed to be the case.


For once in my life, I feel like I made the right decision by going with a tissue valve.

 

[Cris N]

I think I would have made the same decision with that sort of family history. Makes sense not to put yourself through the additional risk.