Abstract
Purpose :
There is widespread consensus that in addition to atherosclerosis, hypercoagulable states contribute to development of CRVO, especially in young patients. Little data exists on the relative prevalence of these risk factors in young CRVO patients and prior studies have demonstrated low rates of positive hypercoagulability test results, calling into question the clinical utility of regular testing. We sought to ascertain the prevalence of thrombotic states and thromboembolic disease in a large cohort of patients under age 50 diagnosed with CRVO.
Methods :
A cohort of patients younger than 50 newly diagnosed with CRVO from a large national insurance claims database were analyzed. Exclusion occurred for having <2 years in the database prior to diagnosis, having a previous vein occlusion of any kind, or a history of hypercoagulable disorder. Hypercoagulable conditions included deep vein thrombosis and pulmonary embolism; hypercoagulable states including antiphospholipid antibody syndrome, protein C and/or S deficiency, Factor V Leiden, hyperhomocysteinemia and cancer. ICD-9 and ICD-10 codes were used for all diagnosis criteria. All patients were then assessed to determine if they had a hypercoagulable work up via laboratory testing within 90 days of diagnosis or a diagnosis for a hypercoagulable state within 1 year of diagnosis. Classic older risk factors such as hypertension (HTN) and diabetes (DM) were also assessed.
Results :
982 patients met inclusion criteria of which 553 (56.3%) were men. Prior to CRVO diagnosis, 356 (36.3%) had HTN, 187 (19.0%) had DM, and 406 (41.3%) had one or the other. Rates increased to 407 (41.4%) and 208 (21.2%) afterwards for HTN and DM, respectively. Only 365 (37.2%) patients had hypercoagulable testing within 90 days of diagnosis. 101 (10.3%) patients in the total cohort were found to have a hypercoagulable state within 1 year after diagnosis of CRVO. This rate was essentially unchanged in those without DM or HTN with 60 (10.4%) of the 576 young patients without DM or HTN being diagnosed with a hypercoagulable state the year following CRVO diagnosis.
Conclusions :
The prevalence of hypercoagulable state was over 10% in patients age 50 and younger with CRVO, with or without cardiovascular disease risk. These results suggest that pursuing a hypercoagulability workup in these individuals has a high clinical utility.
This is a 2020 ARVO Annual Meeting abstract.