High prevalence of thrombophilic risk factors in patients with central retinal artery occlusion

Abstract

Introduction Central retinal artery occlusion (CRAO) is a common cause of blindness and visual morbidity. In the majority of cases, it is related to thrombotic embolism. Nevertheless, the role of inherited or acquired thrombophilic risk factors in CRAO pathogenesis has not been comprehensively studied. Methods In 126 CRAO patients (66 [52.4%] men, median age 55 [range: 18–80] years) and 107 matched controls (56 [52.3%] men, median age 53 [range: 34–78] years) we evaluated classical atherosclerotic risk factors, including serum lipid profile and glucose level, analyzed intima-media complex thickness (IMT) of external carotid arteries, and performed transthoracic echocardiography. Furthermore, we established the prevalence of inherited and acquired thrombophilic risk factors, such as factor V Leiden (FVL) and prothrombin 20210 G/A genetic variants, plasma activity of factor (F) VIII, protein C and antithrombin activity, and free protein S levels. We also assessed the presence of antiphospholipid antibodies (APLA) and evaluated blood homocysteine in all enrolled subjects. Additionally, we estimated the occurrence of Val34Leu polymorphism of the A subunit of coagulation factor XIII (FXIII-A) in both groups as a potential thrombosis-protecting factor. Results Among traditional atherosclerotic risk components, obesity/overweight and hypercholesterolemia were the most common in the CRAO group and occurred in 103 (81.7%) and 85 (67.5%) patients, respectively. CRAO patients also had elevated IMT and altered echocardiographic parameters, indicating diastolic cardiac dysfunction. In thrombophilia investigations, at least one laboratory risk factor occurred in 72.2% (n = 91) of CRAO patients, with APLA as the most frequent, detected in 38.1% (n = 48) of them (almost seven times more frequent than in controls, p < 0.001). Deficiencies in protein C activity and free protein S levels were also common in the CRAO group, reported in 17.5% (n = 22) and 19.8% (n = 25) of patients, respectively. Interestingly, among two analyzed prothrombotic genetic variants, only the FVL was related to CRAO, with the allelic frequency 2.4 times more prevalent than in controls (p = 0.044). Finally, the CRAO group was characterized by hyperhomocysteinemia, almost twice as common as in controls (p = 0.026). Antithrombin deficiency, elevated FVIII, and FXIII-A Val34Leu polymorphism were not associated with CRAO. Conclusions Our findings suggest that thrombophilia plays a vital role in the pathogenesis of CRAO. Thus, proper laboratory screening should be considered in the primary and secondary prevention of those episodes, with implementing appropriate therapy as needed.

A case study of acute invasive fungal sinusitis complicating central retinal artery occlusion

“…The above results indicated that the patient's blood was hypercoagulable, and the patient's The white blood cell count uctuated around 19.35-22.9210^9/L (reference value 3.5-9.5), C-reactive protein 235.14 mg/L (reference value ≤ 6), and calcitoninogen uctuated from 1.11 ng/mL to 2.59 ng/mL (reference value 0-0.05), so the formation of thrombus was probably closely related to the fungal infection and the increasing level of systemic in ammatory factors.There have also been studies that suggest that thrombophilia plays a vital role in the pathogenesis of CRAO. Thus, proper laboratory screening should be considered in the primary and secondary prevention of those episodes, with implementing appropriate therapy as needed [19] .The combination of these ndings suggests that this case is a case of atherosclerotic CRAO, which is currently being treated with conservative treatments such as vasodilatation and intraocular pressure lowering, as well as aggressive treatments such as thrombolysis and Nd:YAG laser. Although there are no high-quality studies demonstrating that the visual prognosis of conservative treatment is better than that of the natural course of the disease [20] , it has been observed clinically that patients who present to the clinic within 4-6 hours of onset of the disease and who are treated promptly with conservative emergency care usually do not have blindness, and typically retain light-sensitive vision and beyond.…”

Research into New Molecular Mechanisms in Thrombotic Diseases Paves the Way for Innovative Therapeutic Approaches

“…Inherited or acquired PC deficiency is associated with a hypercoagulable state leading to VTE and often contributes to familial thrombophilia [ 60 ]. In central retinal artery occlusion (CRAO), deficiency of PC and PS is common, suggesting that they play a role in thrombophilia risk [ 63 ]. The increased clotting activity observed in thrombophilic patients with a familial deficiency of PC or PS is attributed to the impaired activation of PC, which is mediated by TM and PS.…”

Neuroprotective and Anti-Inflammatory Activities of Hybrid Small-Molecule SA-10 in Ischemia/Reperfusion-Induced Retinal Neuronal Injury Models

“…It is a hallmark pathological feature in many retinal neurodegenerative diseases, including diabetic retinopathy (DR), dry age-related macular degeneration (AMD), glaucoma and central retinal artery occlusion (CRAO) [ 1 , 2 , 3 ]. CRAO, an analogue to cerebral stroke in the eye, is an ocular emergency that causes visual morbidity and is often linked to embolism in older people [ 4 ]. The transient occlusion of the central retinal artery obstructs blood supply to the retina, resulting in acute oxygen deprivation, limitation of metabolic substrates and energy depletion.…”