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Zahra K. Ali, Judy Tessema, Victoria Hill, S. R. Witherspoon, Brian Sullivan; The Outcome of Hypercoagulable Studies in Young Patients with NAION. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4889. doi: https://doi.org/.
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To evaluate the outcomes of hypercoagulable work up in young patients with non-arteritic anterior ischemic optic neuropathy (NAION).
Records of all patients with NAION under the age of 55 seen at the University of Texas Southwestern (UTSW) Medical Center between 1995-2010 by two neuro-ophthalmologists were retrospectively reviewed. Demographic data and risk factors for the development of NAION were evaluated. Results and total cost of laboratory work up (including basic serologies, hypercoagulable, infectious, inflammatory and toxic/metabolic studies), sleep studies, and imaging was recorded. Initial management and changes in management as a result of testing were evaluated.
29 patients under 55 years of age were found to have a diagnosis of NAION. Sixty two percent (18/29) of case underwent at least a partial hypercoagulable workup. Three patients had abnormalities on laboratory testing. Of these, one patient, who was found to have elevated beta 2 - glycoprotein levels, decreased protein C activity, and Factor V Leiden heterozygosity , underwent a change in management as a result of the hypercoagulable work up. Cost of the hypercoagulable work up totaled $13,639.10 using third party billing rates at UTSW. Complete ancillary testing (including infectious, inflammatory, and toxic/metabolic laboratory studies, sleep studies, and imaging) in these patients changed the management in three patients. Two were started on CPAP therapy after sleep study revealed moderate to severe sleep apnea. A third patient was started on monthly vitamin B12 injections after work up revealed low levels of vitamin B12. Complete work up costs totaled $246,951.60.
Hypercoagulable studies in young patients with nonarteritic ischemic optic neuropathy have a low yield and usually do not change management decisions. Consideration should be made to ordering hypercoagulable studies that might result in a direct change in management in these patients.
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