Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes

Will S Kurtz,1 Charles J Glueck,1 Robert K Hutchins,2,3 Robert A Sisk,2,3 Ping Wang1 1Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, 2Cincinnati Eye Institute, 3Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Backgrou...

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Autores principales:	Kurtz WS, Glueck CJ, Hutchins RK, Sisk RA, Wang P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	thrombophilia ocular thrombosis retinal vascular occlusion CRVO BRAO pregnancy miscarriage fetal loss Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/922e3bc611b7486b95a0adcb7b55ca29
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spelling	oai:doaj.org-article:922e3bc611b7486b95a0adcb7b55ca292021-12-02T09:17:53ZRetinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes1177-5483https://doaj.org/article/922e3bc611b7486b95a0adcb7b55ca292016-05-01T00:00:00Zhttps://www.dovepress.com/retinal-artery-and-vein-thrombotic-occlusion-during-pregnancy-markers--peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Will S Kurtz,1 Charles J Glueck,1 Robert K Hutchins,2,3 Robert A Sisk,2,3 Ping Wang1 1Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, 2Cincinnati Eye Institute, 3Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Background: Ocular vascular occlusion (OVO), first diagnosed during or immediately after giving birth, often reflects superposition of the physiologic thrombophilia of pregnancy on previously undiagnosed underlying familial or acquired thrombophilia associated with spontaneous abortion, eclampsia, or maternal thrombosis. Specific aim: We describe OVO, first diagnosed during pregnancy or immediately postpartum, in three young females (ages 32, 35, 40) associated with previously undiagnosed familial thrombophilia. Results: Branch retinal artery occlusion (BRAO) occurred at 9 and 13 weeks gestation in two females, aged 32 and 35. Central retinal vein occlusion occurred immediately postpartum in a 40-year-old. One of the two females with BRAO subsequently developed eclampsia, and one had a history of unexplained first trimester spontaneous abortion. All three females were found to have previously unexplained familial thrombophilia. The two females with BRAO had low first trimester free protein S 42 (41%), lower normal limit (50%), and one of these two had high factor VIII (165%, upper normal limit 150%). The woman with central retinal vein occlusion had high factor XI (169%, upper normal limit 150%). Enoxaparin (40–60 mg/day) was started and continued throughout pregnancy in both females with BRAO to prevent maternal–placental thrombosis, and of these two females, one had an uncomplicated pregnancy course and term delivery, and the second was at gestational week 22 without complications at the time of this manuscript. There were no further OVO events in the two females treated with enoxaparin or in the untreated patient with postpartum eclampsia. Conclusion: OVO during pregnancy may be a marker for familial or acquired thrombophilia, which confers increased thrombotic risk to the mother and pregnancy, associated with spontaneous abortion or eclampsia. OVO during pregnancy, particularly when coupled with antecedent adverse pregnancy outcomes, should prompt urgent thrombophilia evaluation and institution of thromboprophylaxis to prevent adverse maternal and fetal–placental thrombotic events. Keywords: thrombophilia, ocular thrombosis, retinal vascular occlusion, CRVO, BRAO, pregnancy, miscarriage, fetal loss, ocular vascular occlusion, pre-eclampsia, eclampsiaKurtz WSGlueck CJHutchins RKSisk RAWang PDove Medical Pressarticlethrombophiliaocular thrombosisretinal vascular occlusionCRVOBRAOpregnancymiscarriagefetal lossOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2016, Iss Issue 1, Pp 935-938 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	thrombophilia ocular thrombosis retinal vascular occlusion CRVO BRAO pregnancy miscarriage fetal loss Ophthalmology RE1-994
spellingShingle	thrombophilia ocular thrombosis retinal vascular occlusion CRVO BRAO pregnancy miscarriage fetal loss Ophthalmology RE1-994 Kurtz WS Glueck CJ Hutchins RK Sisk RA Wang P Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes
description	Will S Kurtz,1 Charles J Glueck,1 Robert K Hutchins,2,3 Robert A Sisk,2,3 Ping Wang1 1Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, 2Cincinnati Eye Institute, 3Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Background: Ocular vascular occlusion (OVO), first diagnosed during or immediately after giving birth, often reflects superposition of the physiologic thrombophilia of pregnancy on previously undiagnosed underlying familial or acquired thrombophilia associated with spontaneous abortion, eclampsia, or maternal thrombosis. Specific aim: We describe OVO, first diagnosed during pregnancy or immediately postpartum, in three young females (ages 32, 35, 40) associated with previously undiagnosed familial thrombophilia. Results: Branch retinal artery occlusion (BRAO) occurred at 9 and 13 weeks gestation in two females, aged 32 and 35. Central retinal vein occlusion occurred immediately postpartum in a 40-year-old. One of the two females with BRAO subsequently developed eclampsia, and one had a history of unexplained first trimester spontaneous abortion. All three females were found to have previously unexplained familial thrombophilia. The two females with BRAO had low first trimester free protein S 42 (41%), lower normal limit (50%), and one of these two had high factor VIII (165%, upper normal limit 150%). The woman with central retinal vein occlusion had high factor XI (169%, upper normal limit 150%). Enoxaparin (40–60 mg/day) was started and continued throughout pregnancy in both females with BRAO to prevent maternal–placental thrombosis, and of these two females, one had an uncomplicated pregnancy course and term delivery, and the second was at gestational week 22 without complications at the time of this manuscript. There were no further OVO events in the two females treated with enoxaparin or in the untreated patient with postpartum eclampsia. Conclusion: OVO during pregnancy may be a marker for familial or acquired thrombophilia, which confers increased thrombotic risk to the mother and pregnancy, associated with spontaneous abortion or eclampsia. OVO during pregnancy, particularly when coupled with antecedent adverse pregnancy outcomes, should prompt urgent thrombophilia evaluation and institution of thromboprophylaxis to prevent adverse maternal and fetal–placental thrombotic events. Keywords: thrombophilia, ocular thrombosis, retinal vascular occlusion, CRVO, BRAO, pregnancy, miscarriage, fetal loss, ocular vascular occlusion, pre-eclampsia, eclampsia
format	article
author	Kurtz WS Glueck CJ Hutchins RK Sisk RA Wang P
author_facet	Kurtz WS Glueck CJ Hutchins RK Sisk RA Wang P
author_sort	Kurtz WS
title	Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes
title_short	Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes
title_full	Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes
title_fullStr	Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes
title_full_unstemmed	Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes
title_sort	retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/922e3bc611b7486b95a0adcb7b55ca29
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Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes

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