Selective thrombophilia screening of patients with nonarteritic anterior ischemic optic neuropathy

Abstract

To date, the question whether there is a relationship between thrombophilic disorders and the development of nonarteritic ischemic optic neuropathy (NAION) remains controversial. We sought to investigate the prevalence of various coagulation defects among NAION patients <65 years of age, and to provide clinical guidelines for a selective thrombophilia screening. A cohort of 35 patients <65 years of age with NAION and 70 controls matched for age and sex were prospectively screened for thrombophilic risk factors. Overall, thrombophilic defects were found to be present in 18 of 35 patients (51.4%) and in 12 of 70 (17.1%) controls (P = 0.0005). The most frequent coagulation disorders were increased levels of factor VIII (P = 0.015) and lipoprotein (a) (P = 0.005). Patients without cardiovascular risk factors had a statistically significant higher frequency of coagulation disorders than patients with these risk factors (P = 0.0059). There was a strong association of coagulation disorders and a personal or family history of thromboembolism (P = 0.028). Moreover, we determined the age of <or=55 years at the time of the first thromboembolic event or NAION as a strong predictor of underlying thrombophilia (P = 0.0002). Our results indicate that thrombophilic disorders are associated with the development of NAION in specific subgroups of patients. Selective screening of young patients, subjects with a personal or family history of thromboembolism, and patients without cardiovascular risk factors may be helpful in identifying NAION patients with thrombophilic defects.