Thrombophilia and vascular risk factors in retinal vein occlusion

Abstract

Background: The importance of vascular risk factors (VRF) and hypercoagulable state in patients with retinal vein occlusion (RVO) has not been conclusively established.

Objectives: To analyze the relevance of VRF, prevalence of thrombophilia, and ultrasonography findings in the supra-aortic trunks in patients with RVO.

Patients and methods: A prospective study was performed of all the patients diagnosed of RVO referred to an Internal Medicine clinic. The clinical, laboratory (including a thrombophilia panel) and ultrasonographic variables were analyzed.

Results: A total of 98 patients (56 men, 42 women) mean age 66 years, were studied. Hypertension and dyslipidemia were the most prevalent VRF. Of these, 24% had hyperhomocysteinemia and atherosclerotic plaques were detected in the supra-aortic trunks in 48%. RVO was peripheral in 69 and central in 29. Genetic thrombophilia was detected in 13% and it was acquired in 9%. Thrombophilia was observed in 50% of subjects aged <50 years and in 67% of those without VRF (P=.004). Seventy-seven percent received antiplatelet drugs. Seven were on anticoagulants due to atrial fibrillation, although this did not prevent the development of RVO. Anticoagulation treatment was initiated in 4 cases, this being maintained indefinitely in the three patients diagnosed with antiphospholipid syndrome.

Conclusions: In patients with RVO, it may be recommendable to control classical VRF and measure serum homocysteine levels. Our data also suggest that antiphospholipid syndrome should be ruled out and that a study of thrombophilia should only be considered in subjects aged <50 years or without VRF. Antiplatelet therapy with aspirin is the treatment of choice to reduce the overall vascular risk. Anticoagulation should only be considered in those patients with high-risk thrombophilias.