Selektives Thrombophiliescreening junger Patienten mit venösen retinalen Gefäßverschlüssen

Zusammenfassung

Hintergrund: Die Bedeutung thrombophiler Gerinnungsstörungen für die Entstehung venöser retinaler Gefäßverschlüsse wird immer noch kontrovers diskutiert. Patienten und Methoden: In einer prospektiven Fall-Kontroll-Studie untersuchten wir 74 junge Patienten (≤ 45 Jahre zum Zeitpunkt des retinalen Gefäßverschlusses oder eines früheren thromboembolischen Ereignisses) mit retinalem Zentral-, Hemizentral- oder Astvenenverschluss und 74 gesunde Probanden auf thrombophile Gerinnungsstörungen und kardiovaskuläre Risikofaktoren. Ergebnisse: 38 der 74 Patienten (51,4 %) wiesen thrombophile Gerinnungsstörungen auf, während lediglich bei 8 der 74 Probanden Koagulopathien aufgedeckt werden konnten (p < 0,0001). Darüber hinaus konnten wir thrombophile Gerinnungsstörungen signifikant häufig bei Patienten mit einer auffälligen Familienanamnese hinsichtlich thromboembolischer Komplikationen (p < 0,0001) und bei Patienten ohne kardiovaskuläre Risikofaktoren nachweisen (p = 0,0025). Schlussfolgerung: Unsere Ergebnisse weisen daraufhin, dass Gerinnungsstörungen neben kardiovaskulären Risikofaktoren bei jungen Patienten mit venösen retinalen Gefäßverschlüssen eine pathogenetische Bedeutung zukommt. Eine positive Eigen- oder Familienanamnese hinsichtlich thromboembolischer Ereignisse sowie das Fehlen kardiovaskulärer Risikofaktoren weisen signifikant häufig auf eine zugrunde liegende Thrombophilie hin.

Abstract

Background: The potential impact of coagulation abnormalities on retinal vascular occlusive diseases, individually and in combination with cardiovascular risk factors, remains unclear. Patients and Methods: In a prospective case-control study a cohort of 74 young patients with central, hemicentral or branch retinal vein occlusion (RVO) (≤ 45 years at the time of the RVO or a previous thromboembolic event) and 74 subjects matched for age and sex were prospectively screened for thrombophilic risk factors. Results: Overall, thrombophilic defects were found to be present in 38 of the 74 patients (51.4 %) and in 8 of 74 (10.8 %) controls (p < 0.0001). We found a strong association between the presence of thrombophilic disorders and a family history of thromboembolism (p < 0.0001). Patients without cardiovascular risk factors had a statistically significant higher frequency of coagulation disorders than patients with these risk factors (p = 0.0025). Conclusions: Our results indicate that thrombophilic disorders are associated with the development of retinal vein occlusion. Selective screening of young patients, patients with a personal or family history of thromboembolism, and patients without cardiovascular risk factors may be helpful in identifying retinal vein occlusion patients with thrombophilic defects.

Thrombophilie - APC-Resistenz - Antiphospholipidantikörper - retinale venöse Gefäßverschlüsse

thrombophilia - resistance to APC - antiphospholipid antibodies - retinal vein occlusion

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