Purpose Investigation for familial and acquired thrombophilia and hypofibrinolysis in 77 women with retinal vascular occlusion (either central retinal artery [CRAO] or central retinal vein occlusion [CRVO]), reinforced the importance of obtaining measures of thrombophilia and hypofibrinolysis in the evaluation of underlying causes of CRAO and CRVO, which pose risk for other thrombotic events, particularly obstetric complications⇓.
Methods In 77 women with CRAO or CRVO referred by retinologists for hematologic evaluation, we performed a detailed evaluation of familial and acquired thrombophilia, with focus on thrombotic events, particularly pregnancy complications, including unexplained miscarriage, pre-eclampsia, eclampsia, and HELLP syndrome. We evaluated thrombophilia measurements in 16 (of the total 77) women with CRAO or CRVO who had 2 or more unexplained pregnancy losses compared to 62 healthy normal women without retinal vascular occlusion.
Results Of the 77 women, 24 (39%) had at least 1 miscarriage, and 16 (26%) had 2 or more miscarriages, pre-eclampsia, or eclampsia. Of these 16 women, 8 had 2 miscarriages, 3 had 4 miscarriages, one woman had 6 miscarriages, and one woman had 8 miscarriages. Of the 16 women with retinal vascular occlusion and pregnancy complications, they were significantly more likely to have elevated Factor VIII (40% vs 11%, p=0.014), elevated Factor XI (23% vs 4%, p=0.045), elevated serum homocysteine (31% vs 0%, p=0.0002), compared with 62 healthy normal female controls without history of retinal vascular occlusion. These 16 women were marginally (p=0.058) more likely than the 62 normal controls to have Factor V Leiden heterozygosity (19% vs 3%).
Conclusion Women of childbearing age who presented with retinal vascular occlusion (CRAO or CRVO) had elevated serum factors associated with thrombophilia, which may pose increased risk for deep vein thrombosis, pulmonary embolism, and obstetric complications. Retinologists are important gatekeepers in the diagnosis of heritable ocular thrombosis through the evaluation of early age of onset for retinal vascular occlusion.
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