FRCPath Haem Part 1 MCQs-Haemostasis 475
A 48-year-old man presents to the emergency department with sudden, painless visual loss in his left eye, which developed over the previous 12 hours. Ophthalmological examination confirms a central retinal vein occlusion (CRVO).
His medical history includes:
Hypertension, well controlled on amlodipine
Hypercholesterolaemia
BMI 31 kg/m²
No diabetes
No previous venous or arterial thrombosis
No known thrombophilia
No recent surgery, immobility, trauma or malignancy
He is a non-smoker. Blood pressure is 145/88 mmHg.
Investigations show:
The ophthalmology team asks the haematology registrar whether therapeutic anticoagulation should be commenced urgently.
What is the most appropriate management?
A. Start apixaban for 3 months, as CRVO is a form of unprovoked venous thromboembolism.
B. Start therapeutic LMWH for 7–14 days followed by 3 months of oral anticoagulation.
C. Start therapeutic LMWH and consider continuing treatment for 1–6 months.
D. Start aspirin plus therapeutic LMWH indefinitely because CRVO has a high risk of recurrent systemic venous thrombosis.
E. Do not use anticoagulation because anticoagulants are absolutely contraindicated in all retinal haemorrhagic disorders.
Correct answer: C. Start therapeutic LMWH and consider continuing treatment for 1–6 months.
Explanation
This patient has an acute central retinal vein occlusion (CRVO).
Management should include assessment and treatment of associated risk factors, particularly hypertension and glaucoma, and other cardiovascular risk factors such as diabetes and hypercholesterolaemia.
Routine thrombophilia testing is not recommended in patients with retinal vein occlusion (RVO).
In patients with acute CRVO, treatment with LMWH for 1–6 months should be considered (Grade 2B). Therefore, anticoagulation with LMWH may be appropriate in the acute phase and may be continued for up to 6 months depending on the clinical situation.
Routine treatment with warfarin or antiplatelet agents is not recommended (Grade 2C).
Why the other options are incorrect