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S. A. Callejo, J. Talajic, J. Galic, J. C. Chen; The Role of Coumadin in the Development of Central Retinal Vein Occlussion. Invest. Ophthalmol. Vis. Sci. 2007;48(13):299.
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The purpose of this study is to explore the relationship between systemic anticoagulation with coumadin and the development of CRVO.
Retrospective, comparative, non-interventional case-control study. A chart review of patients with diagnosis of CRVO over a one-year period was performed to obtain patients’ age, gender, use of coumadin, and the presence of associated risk factors for the development of CRVO such as diabetes mellitus and hypertension. In the cases where patients reported coumadin use, this information was corroborated with the patients’ own pharmacy. A group of age-matched dry ARMD patients was used as control. The number of patients taking coumadin was obtained in each groups and compared. Statistical analysis was performed using the X2 test.
A total of 49 patients developed CRVO, 22 were females and 27 were males. The mean age at diagnosis was 69. A total of 46 patients were included in the control group, 19 females and 27 males with a mean age of 75 years. The rate of hypertension and diabetes was similar in both groups. Four of 49 (8.1%) CRVO patients and 2 of 46 (4.3%) dry ARMD patients were taking coumadin. (p >.05).
Although a small percentage of patients taking coumadin were found in both groups limiting statistical analyses, it is worthwhile to note that the percentage of patients taking coumadin in the CRVO group doubles that of the control group. This high rate of CRVO in patients on coumadin can be considered paradoxical as coumadin is frequently used to prevent thrombogenic co-morbidities such as atrial fibrillation or following cardiac valve surgery. Coumadin did not, however, preclude the development of CRVO in which thrombosis at the level of the lamina cribosa is one of the postulated pathophysiologic mechanisms. Coumadin inhibits vitamin K-dependant coagulation factors as well as the anticoagulant proteins C and S, inducing a transient pro-coagulant state until full inactivation of procoagulant proteins occurs. A larger sample size is needed to explore the potential role of coumadin as a risk factor in the development of CRVO.
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