Oral Anticoagulants Associated with Decreased DR Progression Risk

Both patients with baseline non-proliferative DR and without baseline DR exhibited long-term ocular benefits from DOAC usage.  Photo: Josh Z. Yuen, OD, PhD. Click image to enlarge.  Last Wednesday, a group of researchers at ARVO 2025 in Salt Lake City presented their findings related to ocular complications caused by diabetes. Patients with diabetes have increasingly started to use direct oral anticoagulants (DOACs) to manage cardiovascular comorbidities over the past decade or so, but the effect of this drug on the progression of diabetic retinopathy (DR) has not yet been explored much.The researchers of the ARVO paper used the US Collaborative Network within the TriNetX data platform to obtain electronic health records from 118 million patients. Two cohorts were determined: either patients with type II diabetes without baseline DR on DOACs or those with baseline non-proliferative DR on DOACs. Two control groups also existed of patients not on DOACs who either did not have baseline DR or did have baseline non-proliferative DR. Cohorts were also propensity score matched for age, sex, race, ethnicity, hypertension, dyslipidemias, cerebral artery stenosis, BMI, HbA1c and aspirin use.In total, 61,248 patients were included in the analysis who did not have baseline DR on DOACs and 10,237 who had baseline non-proliferative DR on DOACs. In those without baseline DR, use of DOACs was linked to a decreased risk of any DR development at two, five and eight years after initiation of the drug. In those with baseline non-proliferative DR, DOAC use similarly displayed a decreased risk of proliferative DR development at two, five and eight years. Anticoagulant use in both cohorts also yielded results of decreased risks of vitreous hemorrhage, vitrectomy, panretinal photocoagulation and anti-VEGF injections and five and eight years.In their ARVO abstract, the authors of the study explained how “these findings suggest that DOACs are associated with a decreased risk of DR progression and related outcomes for patients with type II diabetes mellitus with or without non-proliferative DR, with stronger protective effects after longer duration of DOAC usage.” They add that more research will be needed to elucidate the mechanism(s) underlying this relationship.Original abstract content ©2025 Association for Research in Vision and Ophthalmology. Zhao A, Shaia J, Kaelber D, Singh R, Talcott K. Use of direct oral anticoagulants is associated with decreased risk of diabetic retinopathy progression: a propensity-matched analysis of United States electronic health record data. ARVO 2025 annual meeting.