Activated protein C resistance and anticoagulant proteins in young adults with central retinal vein occlusion

Abstract

ABSTRACT.Background: Central retinal vein occlusion is a disease that is most common in old people, and often associated with atherosclerosis, hypertension, diabetes or glaucoma. Since these diseases are much less evident in young people, we wanted to investigate the prevalence of disorders in the most common anticoagulant proteins in a group of young patients with central retinal vein occlusion. Methods. 37 consecutive patients younger than 50 years and with a history of central retinal vein occlusion, were analysed for deficiencies of natural inhibitors of coagulation (protein C, S, and antithrombin III), plasminogen, resistance to activated protein C, and the presence of anticardiolipin or lupus anticoagulants. Results. Anticoagulant protein deficiencies were found in 4 patients (11%) and activated protein C resistance in 7 patients (19%). Anticardiolipin or lupus anticoagulants were not found in the patients. Conclusion: Activated protein C resistance and anticoagulant protein deficiencies seem to be important factors to the etiology to central retinal vein occlusion in young patients.

Central retinal vein occlusion and thrombophilia

“…Larsson et al in a study of 37 patients found no cases of plasminogen deficiency (incidence of 0.3% in the normal population). 17 Williamson found normal levels of tissue plasminogen activator but significantly low levels of plasminogen activator inhibitor (PAI) (P = 0.03) indicating a hypofibrinolytic state in his 87 patients with CRVO. 23 The high levels of PAI were confirmed by Gleuk et al who also showed, in 17 patients, a significantly higher level of the 4G/4G and 4G/5G polymorphisms of the PAI gene (P = 0.03).…”

“…Similarly in a study of 37 patients aged Ͻ50 years, three (8%) were found to have deficiency of protein C, protein S or ATIII. 17 Tekeli et al found protein C deficiency in 20% (9/45) of patients with either central or branch vein occlusion. 18 He also identified two cases of protein S deficiency and one of ATIII deficiency, giving an incidence of naturally occurring anticoagulant deficiency of 27% overall.…”

“…Indeed a sub-group analysis by Larsson et al of 23 patients younger than 45 years showed that six (26%) had APCR which was significantly different to their normal control group (P = 0.0466). 17 This study like that of Williamson et al used an early type of APCR assay which proved not to be as accurate as later assays. 23 Indeed Ciardella et al studied 84 patients with CRVO and 70 controls.…”

“…17,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Although many studies suggest an increased frequency of APCR/FVL in patients with CRVO only two out of nine studies in which the incidence of APCR/FVL is compared with a normal cohort is there a significantly increased incidence of this abnormality. Surprisingly both of these studies included patients of any age where one would have anticipated an association with younger patients.…”

Central retinal vein occlusion associated with Sturge Weber syndrome

“…4 However, in the case of bilateral and recurrent CRVO, a systemic cause should be suspected, especially a hyperviscosity or hypercoagulation state, such as abnormal platelet function or anticoagulant protein deficiencies. 5,6 Local ocular conditions such as uncontrolled glaucoma and optic nerve drusen 4,7 should also be excluded in unilateral cases, as these conditions have been reported in association with CRVO.…”