Antithrombotic Agents in Central Retinal Vein Occlusion

Ryan W. Shultz, MD; Sophie J. Bakri, MD


March 09, 2012

Central and Hemicentral Retinal Vein Occlusion: Role of Anti-Platelet Aggregation Agents and Anticoagulants

Hayreh SS, Podhajsky PA, Zimmerman MB
Ophthalmology. 2011;118:1603-1611

Study Summary and Viewpoint

Central retinal vein occlusion (CRVO) and hemiretinal vein occlusion (hemi-CRVO) may be associated with significant vision loss. Hayreh and colleagues investigated the role of anticoagulant and antiplatelet (aspirin) use in visual outcomes in patients with ischemic and nonischemic CRVO and hemi-CRVO. The cohort study included 567 patients with ischemic and nonischemic CRVO and 119 patients with hemi-CRVO. The main outcome measures were visual acuity (VA), visual fields (VFs), and the severity of retinal hemorrhages.

The odds ratio (OR) for visual deterioration (loss of 3 lines of Snellen VA) for aspirin users vs nonusers was 2.24 (P = .02). In patients who had complete resolution of macular edema, a higher ratio of visual deterioration in aspirin users vs nonusers was suggested (P = .055). For all forms of venous occlusion, patients taking aspirin had significantly more retinal hemorrhage at presentation. Patients with nonischemic vein occlusions on aspirin also did worse on VF testing at presentation, but at final follow-up, the groups did not differ. Aspirin use did not have an effect on resolution of macular edema or conversion to ischemic vein occlusion. Aspirin users did, however, have a higher prevalence of cardiovascular comorbidities.

This study reports that the use of antiplatelet medication in patients with nonischemic CRVO or hemi-CRVO may be associated with decreased VA outcomes. The investigators advise aspirin or anticoagulant use for systemic indications, but not solely for CRVO or hemi-CRVO. These findings will help guide the physician treating patients with CRVO and hemi-CRVO.