Alors que beaucoup préconisent encore de donner en traitement des occlusions de la veine centrale de la rétine des antiagrégants plaquettaires (type aspirine) voire des anticoagulants, une étude présentée à l’ARVO semble démontrer qu’au contraire, certains d’entre eux pourraient en être un facteur de risque indépendant !
FORT LAUDERDALE, Fla. — Antithrombotic medications aspirin and warfarin are independent risk factors for the development of central retinal vein occlusion, according to one researcher speaking here.
« Past hypotheses have centered on the thrombus, » Hideki Koizumi, MD, said at the Association for Research in Vision and Ophthalmology meeting.
Dr. Koizumi presented data from 144 consecutive patients with central retinal vein occlusion CRVO who were compared with 144 gender- and age-matched controls to determine risk factors.
Mean age of CRVO patients was 70 years, and mean age of control patients was 69 years. Male-to-female ratio was 87:57 in both groups.
In addition to known CRVO risk factors such as hypertension, diabetes mellitus, atrial fibrillation and glaucoma, aspirin and warfarin were significantly linked to CRVO by univariate analysis, according to the study results.
Multivariate logistic regression model also found aspirin and warfarin to be independent risk factors for CRVO, he said.
« While these findings imply the vasculopathic and prothrombotic risks in some patients may not be fully addressed by antithrombotic therapy, they also suggest the pathogenesis of CRVO may be more complicated than just the development of a primary thrombus within the vein, » Dr. Koizumi said.
Bien sûr, il faudra lire en détail la publication pour conclure…
Cependant, vu le nombre de patients déjà sous ce type de traitements lorsque survient l’occlusion veineuse rétinienne, il est déjà fort probable qu’ils ne servent à rien…
Via OSN SuperSite.
Abstract complet :
H. Koizumi, D.C. Ferrara, C.Brue, R.F. Spaide.
LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY;
University Politecnica delle Marche, Ancona, Italy.
Purpose: To investigate risk factors for central retinal vein occlusion (CRVO).
Methods: Consecutive patients with CRVO seen from July 2005 through July 2006 were compared with a historical gender- and age-matched control group. The data was obtained by retrospective review of the medical records of the patients’ visits.
Results: The mean age of the CRVO group (N=144) was 69.6 years (SD, 13.6 years; range, 24.8 to 94.2 years), and of the control group (N=144), 68.9 years (SD, 15.2 years; range, 17.8 to 94.7 years). The male-female ratio for both groups was 87:57. CRVO was associated with hypertension (P<0.001), diabetes mellitus (P=0.047), glaucoma (P<0.001), atrial fibrillation (P=0.036), angiotensin converting enzyme inhibitor use (P=0.022), aspirin use (P<0.001), and warfarin use (P=0.011) by univariate analyses. Post-menopausal estrogen use was more common among women in the control group (P=0.029). Independent predictors for CRVO (odds ratio [OR], 95% confidence interval [CI], P value) were found in glaucoma (OR, 4.75; CI, 2.33-9.71; P<0.001), aspirin use (OR, 2.66; CI, 1.52-4.64; P=0.001) and warfarin use (OR, 3.34; CI, 1.44-7.80; P=0.005) by a multivariate logistic regression model. Conclusions: In addition to many of the same risk factors demonstrated by other previous studies, we found both aspirin and warfarin use to be independent risk factors for CRVO. While these findings imply the vasculopathic and prothrombotic risks in some patients may not be fully addressed by antithrombotic therapy, they also suggest the pathogenesis of CRVO may be more complicated than just the development of a primary thrombus within the vein.