From the Guidelines
Antiphospholipid antibody testing is recommended for patients with retinal vein thrombosis, particularly in cases where there are no obvious risk factors or when the patient is young, as it may significantly impact management and prevent recurrent thrombotic events. The testing should include lupus anticoagulant, anticardiolipin antibodies, and anti-β2 glycoprotein I antibodies, and should be performed at least 12 weeks apart to confirm a diagnosis of antiphospholipid syndrome, as transient positivity can occur during acute thrombotic events 1.
Rationale for Testing
The rationale for testing is that antiphospholipid syndrome is an acquired thrombophilia that increases the risk of both arterial and venous thrombosis, including retinal vein occlusion. Identifying this condition is important because it carries a high risk of recurrent thrombotic events in various vascular beds, and proper treatment can prevent these complications.
Patient Selection
Patient selection for antiphospholipid antibody testing should be based on clinical characteristics, with high-risk patients including those with unprovoked venous thromboembolism, arterial thrombosis, or thrombosis at unusual sites, as well as those with autoimmune diseases 1.
Management Implications
A positive result may significantly impact management, potentially leading to long-term anticoagulation therapy rather than antiplatelet therapy alone. Other thrombophilia testing may also be considered as part of a comprehensive workup, especially in younger patients or those with a personal or family history of thrombotic events.
Coordination of Care
It is essential to involve primary care physicians in the management of patients with retinal vein thrombosis, as control of systemic risk factors such as hypertension, diabetes, and lipid disorders is crucial in preventing recurrent thrombotic events 1.
From the Research
Anti-Phospholipid Antibody Testing for Retinal Vein Thrombosis
- The prevalence of antiphospholipid syndrome (APS) in patients with retinal venous occlusion (RVO) has been studied, with one study finding that 13.2% of patients with RVO had APS 2.
- However, the study also found that in patients aged 50 years and older, without previous thrombotic events, antiphospholipid antibodies (aPL) might not be predictive of recurrences, and treatment with aspirin might be sufficient 2.
- Another study found that aPLs were more prevalent in RVO patients than in controls, and that patients with RVO-APS showed a high-risk "aPL profile" 3.
- The study also found that low-dose aspirin was effective in preventing new or recurrent thrombotic events outside the retinal vessels in most RVO patients with APS 3.
- A review of thrombotic antiphospholipid syndrome found that the diagnosis and management of the condition continues to be challenging, and that a practical guide to diagnosis and management is needed 4.
- The review also discussed the use of anticoagulation therapy, including warfarin and direct-acting oral anticoagulants (DOACs), in the management of thrombotic APS 4, 5.
- Another review found that the efficacy of low-dose aspirin in primary thromboprophylaxis is debatable, and that warfarin seems to be the best option for secondary thromboprophylaxis 6.
Recommendations for Testing
- Based on the available evidence, it appears that anti-phospholipid antibody testing may not be routinely recommended for all patients with retinal vein thrombosis, particularly those aged 50 years and older without previous thrombotic events 2.
- However, testing may be considered in patients with a high-risk "aPL profile" or in those with recurrent thrombotic events 3.
- The decision to test for aPL should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 4, 6.