Risk factors, antithrombotic treatment and outcome in retinal vein occlusion: an age‐related prospective cohort study

Objectives Antithrombotic treatment for retinal vein occlusion ( RVO ) is controversial, although RVO has been surmised as a predictor of a subsequent vascular event. We aimed to evaluate risk factors, the effects of antithrombotic therapy and the occurrence of subsequent vascular events in patients with a first episode of RVO , according to age of RVO onset. Methods In this prospective cohort study, patients with central ( CRVO ) and branch RVO ( BRVO ) confirmed by fluorescein angiography were studied; they were divided according to age. Cardiovascular risk factors and thrombophilia were evaluated. Anticoagulants or aspirin were given for at least 3 months. Patients were followed every 6–12 months and vascular events were recorded. Results One hundred CRVO and 32 BRVO patients were enrolled. Five of 60 (8.3%) patients <50 yr and 4/72 (5.5%) over 50 yr had a hereditary thrombophilic defect. One or more cardiovascular risk factors were found in 35 (58%) patients of the younger group, and in 66 (91%) of the older group ( P  < 0.001). Antithrombotic treatment led to both a satisfactory recanalization of occluded veins and visual acuity improvement especially in younger patients. Vascular events occurred in 19 (14%) cases after 4 ± 3.3 yr from RVO , more frequently in older than in younger patients (22% vs. 5%, P  =   0.005). Conclusions Distribution of cardiovascular, but not of thrombophilic risk factors seems to be influenced by age in RVO patients. Patients with a first RVO , especially those >50 yr, are likely at risk of a subsequent vascular event.