Use of thrombolysis for acute myocardial infarction in the presence of diabetic retinopathy in the UK, and associated ocular haemorrhagic complications

Abstract

Diabetic retinopathy is still regarded as a relative contraindication to the use of thrombolysis for myocardial infarction because of a perceived risk of intraocular haemorrhage. However, this complication has rarely been reported and the risk may be too small to justify withholding thrombolysis. A questionnaire survey was therefore conducted of members of the Medical and Scientific Section of the British Diabetic Association (BDA), to ascertain the exclusion criteria applied to the use of thrombolysis in patients with diabetic retinopathy in the UK and to identify any related ocular haemorrhagic complications. Replies were received from 128 physicians in 107 centres. Exclusion criteria applied were: any retinopathy 7 (5%), proliferative retinopathy and recent vitreous or pre-retinal haemorrhage 74 (58%), recent vitreous haemorrhage only 25 (20%), thrombolysis given regardless of retinopathy 22 (17%). No cases of intraocular haemorrhage following thrombolysis in diabetic myocardial infarction patients were identified. The risks of this complication appear to be very small and probably do not justify withholding thrombolytic therapy from diabetic patients with most forms of retinopathy, including proliferative.