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.
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