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.