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Background and aim: By
presenting a case with age-related macular
degeneration (ARMD) and pulmonary
thromboembolism (PTE), the relationship of these
two conditions will be discussed.
Case presentation: A 70 year old man presents
PTE. He had a history of ARMD of the left eye 5
years ago, but with incomplete improvement
despite repeated intra-ocular avastin
injections. Heparin and then warfarin therapy
was prescribed for his PTE. Three months after
starting warfarin, blindness of the right eye
occurred. There was no sign of bleeding and
warfarin overdose at this time. Investigations
confirmed ARMD again. Avastin injection was
taken and even during the Avastin injections,
warfarin was not discontinued. Despite the
intra-ocular injections, bleeding complication
was not observed. With the completion of 6
months of anticoagulant therapy for PTE,
warfarin was discontinued. Three months after
cessation of warfarin, the patient re-presented
with a new PTE. Warfarin was started and
additional studies showed lower than normal
levels for protein C and S.
Conclusion: This case can be sources of other
study to detect some blood markers to find any
correlation between hyper coagulate state and
ARMD, effect of warfarin on the ARMD, and
Avastin on thrombosis.
Keywords:
Age related macular degeneration (ARMD),
pulmonary thromboembolism (PTE), coagulopathy,
Avastin injection, Ocular Coherence Tomographer
(OCT) |
