Department of Infectious Disease, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy; Paride Stefanini" Department, Sapienza University of Rome, Rome, Italy.
Department of Medicine and Surgery, Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
J Thromb Haemost. 2023 Feb;21(2):284-293. doi: 10.1016/j.jtha.2022.10.003. Epub 2022 Dec 22.
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.
视网膜静脉阻塞（RVO）是一种常见的血栓性疾病。
在这项荟萃分析中，我们评估了抗凝和抗血小板治疗 RVO 的疗效和安全性。
检索 MEDLINE 和 EMBASE 数据库，截至 2021 年 12 月，纳入了 RVO 患者的观察性研究和随机对照试验。疗效终点为最佳矫正视力提高、复发性 RVO、荧光素血管造影改善、心血管事件，安全性终点为大出血和眼内出血。
共纳入 1422 例患者（15 项研究）。477 例患者接受抗血小板治疗（13 项研究），312 例患者接受抗凝治疗（12 项研究），609 例患者未接受抗血栓治疗（7 项研究）。治疗持续时间为 0.5 至 3 个月。中位随访时间为 12 个月。总体上，58%（95%置信区间[CI]，45%-69%）的患者视力得到改善，抗凝治疗组为 64%（95% CI，58%-71%），抗血小板治疗组为 33%（95% CI，21%-47%）。复发性 RVO 的发生率分别为 11%（95% CI，7%-17%）、7%（95% CI，2%-19%）和 15%（95% CI，8%-28%）。未治疗患者的复发性 RVO 发生率为 9%（95% CI，6%-14%）。大出血的发生率为 5%（95% CI，3%-9%），抗凝治疗组为 4%（95% CI，2%-9%），抗血小板治疗组为 7%（95% CI，2%-23%）。
与抗血小板治疗相比，抗凝治疗可提高视力，减少复发性 RVO 事件，但出血并发症的比例可接受。
