NAION AND ANTICOAGULANTS: BRIDGING THE GAP WITH RATIONALE-BASED THERAPY

Area of Science:

• Ophthalmology
• Neurology
• Vascular Medicine

Background:

• Non-arteritic anterior ischemic optic neuropathy (NAION) is a complex disorder with poorly understood mechanisms and limited treatment options.
• Metabolic risk factors in NAION often overlap with hypercoagulable states, suggesting a potential link.
• Investigating the role of anticoagulant therapy in NAION is crucial for understanding its impact on vascular and visual outcomes.

Purpose of the Study:

• To evaluate the effect of anticoagulant therapy on vascular function and visual outcomes in patients with NAION.
• To compare outcomes between NAION patients with and without hypercoagulation treated with anticoagulant therapy.

Main Methods:

• A prospective interventional study involving two groups of NAION patients: hypercoagulation and non-hypercoagulation.
• All participants received aspirin; the hypercoagulation group also received warfarin.
• Vascular parameters (capillary perfusion, flux index) via OCTA and visual function (visual acuity, visual field) were assessed before and after treatment.

Main Results:

• Both groups showed significant decreases in capillary perfusion (CP) and flux index (FI).
• The hypercoagulation group receiving warfarin demonstrated significant improvements in visual field parameters (MD, VFI).
• While most hypercoagulation patients showed improvement, the non-hypercoagulation group exhibited minimal changes.

Conclusions:

• Anticoagulant therapy may help slow the progression of vascular flow insufficiency in NAION patients.
• Clinical enhancement and improved visual function are potential benefits of anticoagulant therapy in NAION, particularly in hypercoagulable patients.