Parnaparin versus aspirin in the treatment of retinal vein occlusion. A randomized, double blind, controlled study

Ageno, Walter; Cattaneo, Roberto; Manfredi, E; Chelazzi, Paolo; Venco, Luigi; Ghirarduzzi, Angelo; Cimino, Luca; Filippucci, Esmeralda; Ricci, A; Romanelli, Donatella; Incorvaia, Carlo; D’Angelo, Stefano; Campana, Fiamma; F, Molfino; Scannapieco, Gianluigi; Rubbi, F.; Imberti, Davide

doi:10.1016/j.thromres.2009.05.007

Cited by 38 publications

(38 citation statements)

References 34 publications

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“…Since the latter studies reported clinical benefit in patients with central 41 but not branch RVO 38 it might be possible that a more prolonged period of anticoagulation might actually result in a benefit for patients with BRVO, as suggested by the results of the study by Ageno and co-workers. 40 This is, in our opinion, one of the most important issues yet to be determined. Second, even though our results suggest that early anticoagulation initiation is necessary, the optimal time of initiation is still not known.…”

Section: Discussionmentioning

confidence: 96%

Low molecular weight heparin for the treatment of retinal vein occlusion: a systematic review and meta-analysis of randomized trials

Lazo‐Langner

Hawel²,

Ageno³

et al. 2010

Haematologica

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Retinal vein occlusion is a frequent cause of visual loss for which few effective therapies are available. Anticoagulation with low molecular weight heparin might be of value in its treatment. We conducted a systematic review and meta analysis of randomized trials evaluating the effect of low molecular weight heparin in patients with retinal vein occlusion. Data sources included MEDLINE, EMBASE, HealthSTAR, the Cochrane Library, Lilacs, the Investigative Ophthalmology and Visual Science database and gray literature. Main outcome was the mean difference between the visual acuity measured at baseline and at six months expressed in the logMAR scale. Secondary outcome was a composite of any adverse ocular outcome including: worsening of visual acuity, visual fields or fluorescein angiography, or development of iris neovascularization, any neovascularization or neovascular glaucoma. Subgroup analyses for branch versus central retinal vein occlusion were conducted. We identified 1,084 references of which 3 studies comparing low molecular weight heparin with aspirin (229 evaluable patients) were included. Overall, the pooled mean visual acuity difference was -0.23 logMAR (95% CI -0.38, -0.09; P=0.002) in favor of low molecular weight heparin. Low molecular weight heparin was associated with a 78% risk reduction for developing any adverse ocular outcome (pooled RR 0.22; 95% CI 0.10, 0.46; P<0.001). In subgroup analyses benefits seemed lower in branch retinal vein occlusion. No increased vitreous hemorrhages were observed. In patients with retinal vein occlusion treatment with low molecular weight heparin seems to be associated with improvement in the visual acuity and less adverse ocular outcomes. These benefits might differ in patients with central as opposed to branch retinal vein occlusion. Further studies are required to confirm these findings and clarify its benefits in specific subgroups of patients before definitive recommendations can be made. IntroductionRetinal vein occlusion (RVO) is a common and important cause of visual loss. In population-based studies its prevalence has been reported to be around 0.6% and up to 4.6% in patients 80 years old or older with a 10-15 year cumulative incidence ranging between 1.6 and 1.8%.1-4 Studies evaluating predictors of RVO have consistently shown an association with risk factors for atherosclerosis such as hypertension, dyslipidemia, and diabetes 4,5 as well as ocular comorbidities such as glaucoma; 5,6 conversely, it has been suggested that the presence of RVO in patients under 70 years of age might be associated with increased cardiovascular mortality.7 In contrast, the association between RVO and thrombophilic risk factors for venous thrombosis, such as factor V Leiden, prothrombin G20210A, and deficiencies of antithrombin, protein C and protein S seems to be weak at best. The exceptions are hyperhomocysteinemia and the presence of antiphospholipid antibodies which are associated with an odds ratio (OR) for developing RVO of 8.9 and 3.9, respectively. 8 Long-term...

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Section: Discussionmentioning

confidence: 96%

Low molecular weight heparin for the treatment of retinal vein occlusion: a systematic review and meta-analysis of randomized trials

Lazo‐Langner

Hawel²,

Ageno³

et al. 2010

Haematologica

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“…São erros comuns nas análises: (1) inclusão de pacientes com tratamentos prévios, não raro múltiplos; (2)oclusões de ramo analisadas junto com as de veia central numa única amostra; (3) durações prévias diferentes dos quadros; (4) seguimento variável; (5) ausência de controles; (6) falta de randomização e cegamento; (7) amostras pequenas; (8) formas isquêmicas e não isquêmicas determinadas por critérios não uniformes ou discutíveis (como é o caso do CVOS (5) que fez uso das 10 zonas de diâmetro de disco de não perfusão capilar). Assim avolumam-se os relatos sobre anticoagulantes (parnaparina (15) ), trombolíticos (sistêmicos, locais, em doses diferentes (13) , laser "subtreshold" (16) , triancinolona ou antiVEGF intravítreos (8,(17)(18)(19)(20)(21) , complexas cirurgias (22,23) (vitrectomia, neurotomia, canulizações, "sheatotomy" nos cruzamentos vasculares). Hattenbach (13) , mesmo tendo misturado casos com ORV e OVC num mesmo grupo, mostra que a rt-PA foi superior a história natural e aos casos tratados pela iso-hemodiluição quando manejados nos primeiros 10 dias de oclusão.…”

Section: Oclusões Venosas Da Retina -Tendências E Cautelasunclassified

Oclusões venosas da retina - tendências e cautelas

Vilela¹

2010

Rev. bras.oftalmol.

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“…All studies report partial improvement of visual acuity, but studies comparing LMWH with aspirin suggest that anticoagulant treatment may be more effective than antiplatelet treatment in the first few weeks after RVO, in particular if the occlusion involves the central retinal vein [11][12][13]. The results of these three studies were subsequently meta-analyzed, and LMWH shows a visual acuity improvement at 6 months (-0.23 logMAR units or 2 lines), and a 78% risk reduction for developing adverse ocular outcomes with no increased risk of vitreous hemorrhage [14].…”

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confidence: 99%