Long-term outcomes of antithrombotic treatment for retinal vein occlusion

Abstract

Background

Retinal vein occlusion (RVO) is a leading cause of visual impairment. Several cardiovascular and thrombotic predisposing factors have been linked to RVO. Antithrombotic agents are commonly prescribed, but their effectiveness for visual recovery and long-term outcomes remains uncertain.

Objectives

To study the course of long-term clinical outcomes in RVO patients.

Methods

In this multicenter, retrospective, observational study of patients with an index RVO at 3 academic hospitals, we estimated the risk of recurrent RVO, cardiovascular events, venous thromboembolic events, bleeding complications, and death, reported as incidence rates per 100 person-years, and compared these rates between patients treated with antithrombotic drugs and those untreated.

Results

Between 2004 and 2023, 198 patients were enrolled (median age, 65 years; IQR, 54-75; 105 females, 53.0%) and followed for a median of 2.6 years (IQR, 0.9-4.5); of these, 39.4% received antiplatelet therapy, 16.6% received anticoagulant therapy, and 44.0% received no antithrombotic treatment. The median duration of anticoagulant therapy was 46 days (IQR, 30-158), while that of antiplatelet therapy was 296 days (IQR, 124-947). The incidence rate ratios (IRRs) for cardiovascular events and mortality were higher in the untreated group (IRR, 6.04; 95% CI, 1.17-38.9 for cardiovascular events; IRR, 3.89; 95% CI, 1.29-12.3 for mortality) than in patients receiving antithrombotic treatment. For RVO recurrence and hemorrhagic complications, we found no differences between treated and untreated patients (IRR, 1.02; 95% CI, 0.18-3.97 for recurrent RVO; IRR, 1.12; 95% CI, 0.4-2.76 for bleeding complications).

Conclusion

In this real-world cohort study of RVO, our data suggest that patients with RVO should undergo careful cardiovascular risk assessment. Antithrombotic therapy should not be used routinely after RVO, only when indicated by established cardiovascular prevention principles or specific clinical circumstances. Notably, rates of recurrent RVO and bleeding complications were similar between treated and untreated patients.