RVO patients at risk for further CV events
MedWire News: Patients with retinal vein occlusions (RVOs) are at risk for further episodes of thrombosis, Italian researchers have found.
“The uncertainties of RVO include clinical management and optimal treatment, as no rigorous evidence is available concerning the efficacy of the different therapeutic approaches, in particular with respect to antithrombotic strategies,” explain Antonio Coppola (Federico II University of Naples) and co-authors.
To investigate further, the team examined the prevalence of cardiovascular risk factors and thrombophilia in 117 patients, aged an average of 51 years, with central (n=62), branch (n=48), or both forms of RVO, and 202 age- and gender-matched apparently healthy volunteers.
As reported in the Journal of Thrombosis and Thrombolysis, RVO patients were more than four times more likely than controls to have arterial hypertension (64.9% vs 28.2%) and more than twice as likely to have diabetes mellitus (17.9% vs 7.9%).
However, RVO was not significantly predicted by levels of the thrombophilia markers antithrombin, protein C, protein S, and homocysteine. Nor was RVO significantly associated with lupus anticoagulant and anticardiolipin antibodies, or the factor V Leiden and prothrombin G20210A thrombophilic mutations.
In all, 90 patients were followed-up for cardiovascular events for an average of 8.2 years, during which time 64% experienced further vascular events. These included arterial ischemic events in 42.2% of patients, venous thromboembolism (VTE) in 11.1%, and recurrent RVO in 11.1%.
The rate of new vascular events was significantly lower among the 22 patients who were treated with antiplatelet agents compared with the 68 patients who were not (45% vs 70%). Indeed, untreated patients accounted for all new VTE events, 84% of arterial ischemic events, and the only cardiovascular-related death, and three of the four patients positive for antiphospholipid antibodies had new events.
Branch RVO patients had a higher rate of hypertension and diabetes than central RVO patients, and were also significantly more likely to experience vascular events during follow-up (69% vs 59%).
“Our data support the high-risk cardiovascular profile of RVO patients and the need for prospective interventional trials, with large sample-size and well-defined clinical endpoints, to assess efficacy and safety of antiplatelet treatment in the long-term secondary vascular prevention in this setting,” Coppola et al conclude.
“In the meanwhile, the (pharmacological and not) correction of conventional vascular risk factors, in particular of arterial hypertension and of diabetes mellitus, appears to be a major approach for primary and secondary prevention of RVO.”
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By Lynda Williams