Ocular vascular thrombotic events: central retinal vein and central retinal artery occlusions.

Abstract

We prospectively assessed associations of thrombophilia- hypofibrinolysis with central retinal vein occlusion (CRVO) (40 patients) and central retinal artery occlusion (CRAO) (9 patients). We used polymerase chain reaction measures for thrombophilia (factor V Leiden, prothrombin, C677T MTHFR, platelet glycoprotein PlA1/A2) and hypofibrinolysis (plasminogen activator inhibitor-1 4G4G). Serologic thrombophilia measures included protein C, protein S (total and free) and antithrombin III, homocysteine, lupus anticoagulant, anticardiolipin antibodies IgG-IgM, and factors VIII and XI. Serologic hypofibrinolysis measures included Lp(a) and plasminogen activator inhibitor activity. For comparison with 40 CRVO and 9 CRAO patients, 80 and 45 race-gender matched controls were studied. The factor V mutation was more common in CRVO (3/40, 8%) than controls (0/79, 0%), P = .036, as was high (>150%) factor VIII (12/40, 30%) versus (4/77, 5%), P = .0002. Low antithrombin III (<80%) was more common in CRVO (5/39, 13%) than in controls (2/73, 3%), P = .049. Homocysteine was high (> or =13.5 micromol/L) in 5/39 (13%) CRVO patients versus 2/78 controls (3%), P = .04. Three of 9 CRAO patients (33%) had low (<73%) protein C versus 2/37 controls (5%), P = .044. Two of 9 CRAO patients (22%) had high (> or =13.5 micromol/L) homocysteine versus 0/42 controls (0%), P =. 028. Four of 9 CRAO patients had the lupus anticoagulant (44%) versus 4/33 (12%) controls (P = .050). CRVO is associated with familial thrombophilia (factor V Leiden, factor VIII, low antithrombin III, homocysteinemia), and CRAO is associated with familial and acquired thrombophilia (low protein C, homocysteinemia, lupus anticoagulant), providing avenues for thromboprophylaxis, and triggering family screening.

• Authors: Charles J Glueck, Ping Wang, Robert Hutchins, Michael R Petersen, Karl Golnik
• Journal: Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis (Clin Appl Thromb Hemost) Vol. 14 Issue 3 Pg. 286-94 (Jul 2008) ISSN: 1076-0296 [Print] United States
• PMID: 18160589 (Publication Type: Journal Article)

Chemical References

• factor V Leiden
• Factor V

Topics

• Adult
• Aged
• Atherosclerosis (blood, etiology, genetics)
• Case-Control Studies
• Factor V (genetics)
• Female
• Fibrinolysis (genetics)
• Humans
• Male
• Middle Aged
• Pregnancy
• Pregnancy Complications, Cardiovascular (blood, genetics)
• Pregnancy Complications, Hematologic (blood, genetics)
• Pregnancy Outcome
• Prospective Studies
• Retinal Artery
• Retinal Artery Occlusion (blood, etiology, genetics)
• Retinal Vein Occlusion (blood, etiology, genetics)
• Risk Factors
• Thrombophilia (blood, complications, genetics)
• Thrombosis (blood, etiology, genetics)