Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Risk of Stroke, Myocardial Infarction, Deep Vein Thrombosis, Pulmonary Embolism, and Death After Retinal Vein Occlusion
TAKE-HOME MESSAGE
-
An analysis of a large database showed that, compared with controls, there was an increased risk of death, stroke, and myocardial infarction in patients after retinal vein occlusion (central or branch retinal vein occlusion), with a slight increase in the risk of deep vein thrombosis at 1 year but no significant increased risk of deep vein thrombosis or pulmonary embolism at 5 and 10 years.
- Eye care providers should communicate this increased risk of significant systemic vascular events among patients with retinal vein occlusion to the patient's primary care provider.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To examine rates of stroke, myocardial infarction (MI), deep vein thrombosis (DVT), pulmonary embolism (PE), and death in patients after retinal vein occlusion (RVO) compared to controls.
DESIGN
Retrospective cohort study.
METHODS
An aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients with diagnosis of RVO and a control group of patients with cataract. Patients were excluded if they had history of stroke, MI, DVT, or PE within 2 years of diagnosis of RVO or cataract. Propensity score matching was performed to control for baseline demographics and medical comorbidities. Main outcomes included relative risk (RR) of death, stroke, MI, DVT, and PE after RVO compared to matched controls.
RESULTS
45304 patients were included in each cohort. There was elevated risk of death in the RVO cohort compared to the control cohort at 1 (RR: 1.30, p<0.01), 5 (RR: 1.22, p<0.01), and 10 years (RR:1.08, p<0.01). There was elevated risk of stroke at 1 (RR:1.61, p<0.01), 5 (RR:1.31, p<0.01), and 10 years (RR: 1.18, p<0.01). There was elevated risk of MI at 1 (RR:1.26, p<0.01) and 5 years (RR:1.13, p<0.01), but not at 10 years (RR:1.06, p=0.12). There was mildly elevated risk of DVT at 1 year (RR: 1.65, p<0.01), but not at 5 (RR: 0.94, p=0.94) or at 10 years (RR: 1.05, p=0.37), There was no elevated risk of PE at 1 (RR: 0.98, p=0.80), 5 (RR: 0.95, p=0.42), or 10 years (RR: 0.85, p=0.40).
CONCLUSIONS
There is an increased rate of death, stroke, and MI after RVO compared to matched controls. We emphasize the need for long term systemic evaluation after RVO.
Additional Info
Disclosure statements are available on the authors' profiles:
Risk of Stroke, Myocardial Infarction, Deep Vein Thrombosis, Pulmonary Embolism, and Death after Retinal Vein Occlusion
Am J Ophthalmol 2023 Sep 01;[EPub Ahead of Print], KM Wai, CA Ludwig, E Koo, R Parikh, P Mruthyunjaya, E RahimyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Retinal vascular occlusions involving the retinal arteries or retinal veins (RVO) can result in significant debilitating vision loss for afflicted patients. Both conditions have been associated with underlying cardiovascular comorbidities — including diabetes, hypertension, hyperlipidemia, and older age — among others. While retinal artery occlusions are traditionally thought to be a stroke analog and managed as such, less is known about the potential systemic risk for patients with RVOs to experience a subsequent vascular event. Furthermore, it is not well elucidated whether any increased risk applies to other venous thromboembolic disease (ie, pulmonary embolism and deep vein thrombosis) versus arterial disease (ie, cerebrovascular accident and myocardial infarction).
The objective of this study was to examine rates of stroke, myocardial infarction, deep vein thrombosis, pulmonary embolism, and death in patients after experiencing an RVO compared with a propensity score–matched control group. The study was carried out utilizing an electronic health records research network, TriNetX, comprising more than 119 million patients, resulting in the largest study on RVOs to date. More than 45,000 patients with RVO were included in the analysis. The outcomes were measured at 1, 5, and 10 years after initial diagnosis of the RVO. There were elevated risks of stroke, myocardial infarction, and death observed throughout the study duration; however, minimal differences were noted when comparing the RVO cohort with the control group for other venous embolic phenomena (pulmonary embolism and deep vein thrombosis). Logically, one may surmise that a patient with an RVO may have an elevated risk of other venous occlusive events in the body, but interestingly, this did not turn out to be the case in this study.
Overall, this type of study emphasizes the need for coordinated multidisciplinary care for patients with retinal diseases that may also be predictive of underlying systemic disease and the risk of potential future events. From an eye care provider’s perspective, the findings of this study heighten the importance of ensuring a patient’s cardiovascular comorbidities are being optimally controlled in conjunction with their primary care provider and/or cardiologist.