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THROMBOLYSIS NOT CONTRAINDICATED WITH DIABETIC RETINOPATHY.

Diabetic hemorrhagic retinopathy is often considered an absolute contraindication to thrombolytic therapy because of anecdotal reports of intraocular hemorrhage. This study described the incidence of intraocular hemorrhage among 40,899 patients receiving t-PA or streptokinase for acute myocardial infarction. Patients were participants in a major clinical trial of those therapies (GUSTO-I).

Ocular hemorrhage was detected in 12 patients (0.03 percent), and 11 of these hemorrhages were extraocular. Only one confirmed intraocular (subretinal) hemorrhage was found, and it occurred in a patient without diabetes. Among the 5,995 patients in this study with diabetes, just one had an ocular hemorrhage, and it was an eyelid hematoma secondary to a fall.

Comment: This study did not include information on the baseline state of diabetic retinopathy, but we can safely assume that many of these patients had some abnormalities. This report provides assurance that thrombolytic therapy is unlikely to precipitate intraocular hemorrhage in diabetics.

— TH Lee

Published in Journal Watch General Medicine December 9, 1997

Citation(s):

Mahaffey KW et al. Diabetic retinopathy should not be a contraindication to thrombolytic therapy for acute myocardial infarction: Review of ocular hemorrhage incidence and location in the GUSTO-I Trial. J Am Coll Cardiol 1997 Dec 30 1606-1610.

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