Anticoagulant, Antiplatelet Therapies May Protect Against Diabetic Retinopathy

An investigation shows aspirin can help prevent the development of nonproliferative diabetic retinopathy, but has no effect on proliferative disease or macular edema.

Antiplatelet and anticoagulant (APAC) therapy, specifically aspirin and dipyridamole monotherapy, can aid in the prevention of nonproliferative diabetic retinopathy (NPDR) development in patients with type 2 diabetes, according to research published in BMC Ophthalmology 

Researchers selected 73,964 patients for a retrospective cohort study using the Longitudinal Health Insurance Database from Taiwan. Selection criteria required patients be aged at least 20 years, have a recent type 2 diabetes diagnosis, and no prior history of diabetic retinopathy, macular edema, or intravitreal injections. The patients were separated into a test group of those using APACs, and a control group who did not use APACs. Researchers completed a sensitivity analysis to assess the effect APACs had on the development of NPDR, PDR, and DME.

The report shows APACs are associated with a reduced risk of developing NPDR (P <.001), but had no significant effect on PDR and DME. Sensitivity analysis shows that aspirin and dipyridamole each had a significant protective effect against the development of NPDR, even when used alone. When combined with other APACs, aspirin had a more significant protective effect on NDR, most so when combined with dipyridamole (P >.001) and clopidogrel (P >.001).

The researchers suggest that APACs can have a beneficial effect on populations with type 2 diabetes in regard to developing NPDR. While the results relating to PDR and DME were not found to be statistically significant, they suggest more research with a large sample size of patients with PDE and DME for more conclusive results.

Limitations of this study include being limited to the data contained in the Longitudinal Health Insurance Database, the exclusion of participants using APACs for more than 28 days, lack of documentation of the dosage of APACs, and finally, the difficulty in tracking duration of hyperglycemia in patients with type 2 diabetes. 


Jeng CJ, Hsieh YT, Lin CL, Wang IJ. Effect of anticoagulant/antiplatelet therapy on the development and progression of diabetic retinopathy. BMC Ophthalmol. Published online March 17, 2022. doi:10.1186/s12886-022-02323-z