Retinal vein occlusions in patients taking warfarin.

OBJECTIVE

To describe development of retinal vein occlusion (RVO) in patients anticoagulated with warfarin.

DESIGN

Retrospective, observational case series.

PARTICIPANTS

Thirteen patients drawn from a private retina practice.

METHODS

Review of clinical records, laboratory results, color fundus photographs, and fluorescein angiograms.

MAIN OUTCOME MEASURES: Primary measures were international normalized ratio (INR), visual acuity, and concurrent systemic disease.

RESULTS

The female-to-male ratio was 7 to 6. Age range was 44 to 86 years, with a median age of 73 years. Two patients had systemic lupus erythematosus, 7 had hypertension, and 2 had primary open-angle glaucoma. Two had laboratory abnormalities: 1 with a combination of lupus anticoagulant and anticardiolipin antibodies and 1 with a combination of hyperhomocystinemia and low antithrombin III. Three patients were taking acetylsalicylic acid in addition to warfarin at the time of the RVO. The INRs at the time of RVO were 0.9 to 3.8, with 9 of 13 <==2.0.

CONCLUSIONS

Anticoagulation with warfarin does not preclude RVO in predisposed patients, nor does combination therapy with warfarin and acetylsalicylic acid. Attention to keeping the INR >2.0 may be helpful.