Antithrombotic treatment for retinal vein occlusion: a systematic review and meta-analysis.


Journal

Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508

Informations de publication

Date de publication:
02 2023
Historique:
received: 18 07 2022
revised: 16 09 2022
accepted: 05 10 2022
pubmed: 27 1 2023
medline: 15 2 2023
entrez: 26 1 2023
Statut: ppublish

Résumé

Retinal vein occlusion (RVO) represents a common thrombotic disorder. In this meta-analysis, we evaluated the efficacy and safety of anticoagulant and antiplatelet therapy in RVO. MEDLINE and EMBASE were searched up to December 2021 for observational studies and randomized controlled trials including patients with RVO. Efficacy outcomes were best-corrected visual acuity improvement, recurrent RVO, fluorescein angiography improvement, cardiovascular events, and safety outcomes were major bleeding and intraocular bleeding. A total of 1422 patients (15 studies) were included. Antiplatelet therapy was administered to 477 patients (13 studies), anticoagulant therapy to 312 patients (12 studies), and 609 (7 studies) patients received no antithrombotic treatment. The treatment duration ranged between 0.5 and 3 months. The median follow-up duration was 12 months. Best-corrected visual acuity improvement was reported in 58% of the patients (95% confidence interval [CI], 45%-69%) overall, 64% (95% CI, 58%-71%) in those on anticoagulant therapy, and 33% (95% CI, 21%-47%) in those on antiplatelet therapy. The rates of recurrent RVO was 11% (95% CI, 7%-17%), 7% (95% CI, 2%-19%), and 15% (95% CI, 8%-28%), respectively. The rate of recurrent RVO in untreated patients was 9% (95% CI, 6%-14%). The rate of major bleeding was 5% (95% CI, 3%-9%) overall, 4% (95% CI, 2%-9%) in those on anticoagulant therapy, and 7% (95% CI, 2%-23%) in those on antiplatelet therapy. Anticoagulant therapy was associated with higher visual acuity improvement and fewer recurrent RVO events than antiplatelet therapy, at the cost of an acceptable proportion of bleeding complications.

Sections du résumé

BACKGROUND
Retinal vein occlusion (RVO) represents a common thrombotic disorder.
OBJECTIVES
In this meta-analysis, we evaluated the efficacy and safety of anticoagulant and antiplatelet therapy in RVO.
METHODS
MEDLINE and EMBASE were searched up to December 2021 for observational studies and randomized controlled trials including patients with RVO. Efficacy outcomes were best-corrected visual acuity improvement, recurrent RVO, fluorescein angiography improvement, cardiovascular events, and safety outcomes were major bleeding and intraocular bleeding.
RESULTS
A total of 1422 patients (15 studies) were included. Antiplatelet therapy was administered to 477 patients (13 studies), anticoagulant therapy to 312 patients (12 studies), and 609 (7 studies) patients received no antithrombotic treatment. The treatment duration ranged between 0.5 and 3 months. The median follow-up duration was 12 months. Best-corrected visual acuity improvement was reported in 58% of the patients (95% confidence interval [CI], 45%-69%) overall, 64% (95% CI, 58%-71%) in those on anticoagulant therapy, and 33% (95% CI, 21%-47%) in those on antiplatelet therapy. The rates of recurrent RVO was 11% (95% CI, 7%-17%), 7% (95% CI, 2%-19%), and 15% (95% CI, 8%-28%), respectively. The rate of recurrent RVO in untreated patients was 9% (95% CI, 6%-14%). The rate of major bleeding was 5% (95% CI, 3%-9%) overall, 4% (95% CI, 2%-9%) in those on anticoagulant therapy, and 7% (95% CI, 2%-23%) in those on antiplatelet therapy.
CONCLUSION
Anticoagulant therapy was associated with higher visual acuity improvement and fewer recurrent RVO events than antiplatelet therapy, at the cost of an acceptable proportion of bleeding complications.

Identifiants

pubmed: 36700511
pii: S1538-7836(22)07169-0
doi: 10.1016/j.jtha.2022.10.003
pii:
doi:

Substances chimiques

Platelet Aggregation Inhibitors 0
Anticoagulants 0

Types de publication

Meta-Analysis Systematic Review Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

284-293

Informations de copyright

Copyright © 2022 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.

Auteurs

Emanuele Valeriani (E)

Department of Infectious Disease, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy; Paride Stefanini" Department, Sapienza University of Rome, Rome, Italy. Electronic address: e.valeriani@policlinicoumberto1.it.

Francesco Paciullo (F)

Department of Medicine and Surgery, Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.

Angelo Porfidia (A)

Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

Pasquale Pignatelli (P)

Experimental Medicine, University of Rome La Sapienza, Rome, Italy.

Matteo Candeloro (M)

Department of Innovative Technologies in Medicine and Dentistry, "G. D'Annunzio" University, Chieti, Italy.

Marcello Di Nisio (M)

Department of Medicine and Ageing Sciences, University "G D'Annunzio", Chieti-Pescara, Italy.

Marco Paolo Donadini (MP)

Department of Medicine and Surgery, University of Insubria, Varese, Italy.

Claudio Maria Mastroianni (CM)

Department of Infectious Disease, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy.

Roberto Pola (R)

Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

Paolo Gresele (P)

Department of Medicine and Surgery, Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.

Walter Ageno (W)

Department of Medicine and Surgery, University of Insubria, Varese, Italy.

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Classifications MeSH