Antiplatelet and Anticoagulant Drugs Do Not Affect Visual Outcome in Neovascular Age-Related Macular Degeneration in the BRAMD Trial

Buitendijk, Gabriëlle H.S.; Schooneveld, Mary van; Wezel, M.; Stam, Henk J.; Jansen-Kok, C.; Althoff, Amanda; Zee, A. van der; Stam, Marloes; Vries, D.J. De; Vingerling, Johannes R.; Postema, N.C. Naus-; Hertoge, K.L. De Roon; Klaver, Caroline C W; Kılıç, Emine; Noordzij, Y.; Noordzij, J Mark; Vermij, A.; Hooghart, Ada J; Dijkman, Greet; Boesten, I.; Jonge, C. Kiewiet de; Haas, Miki; Mollinger, C.; Zwaan, J.W.; Boolman, A.; Hooymans, Johanna M. M.; Kamminga, Noëlle G. A.; Huiskamp, A.E.; Postma, Gina; Meinen, M.; Uwantege, L.; Luurtsema, H.R.; Eisses, John F.; Lavalette, V.W. Ronardel de; Pol, J.P. Van De; Hoyng, Carel B.; Vries, Ankje de; Huntink, Elke; Kalisingh, A.; Hoeks, Lette B E A; Hermans, Hadewich; Rotteveel, A.; Weeda, Jack; Ast, C. Van; Linden, M. van der; Klaver, H.; Hierden, R. van; Coops, A.; Corstanje, K.; Jansen, Michael; Berg, N. van den; Rulo, A; Gerbrandy, F.; Tromp, A.; Cardozol, O. Lopes; Zola, Enrica; Leeuwen, Barbara L. van; Dantuma, G.; Koning, Sander; Baekel, M. van; Selders, M.; Zandee, M.; Goudriaan, M.; Langen, Adrianus J. de; Mortel, Rodrigue; Tetteroo, A.; Groot, Y.; Schlingemann, Reinier O.; Dijkgraaf, Marcel G. W.; Haan, RJ de; Zwinderman, A. H.; Mehmedovic, S.; Dalén, Johan; Corten, I.; Veenstra, Emile B; Strubel, Y.; Verbraak, F. D.; Schauwvlieghe, A.M.E.; Bakker, Dirk J.; Blows, Peter; Ringens, Peter J.; Geskus, Ronald B.; Leeuwen, Redmer van

doi:10.1016/j.ajo.2018.01.003

Cited by 15 publications

(11 citation statements)

References 35 publications

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“…To our knowledge, this study reports for the rst time morphological biomarkers on SD-OCT associated with early SMH occurrence despite recent anti-VEGEF injections on a large cohort of 49 eyes. In accordance with recent study results 11,12 , anticoagulant or antiplatlet use or hypertension have not been associated with early SMH after anti-VEGF injection or bilateral SMH. Moreover, given their demonstrated effects on vital prognosis in cardiovascular disease, their interruption in patients affected by neovascular AMD does not appear justi ed.…”

Section: Discussionsupporting

confidence: 92%

Biomarkers associated with early onset of large submacular hemorrhage secondary to neovascular age-related macular degeneration after anti-VEGF intravitreal injection

Zegrari¹,

Cohen²,

Colantuono

et al. 2023

Preprint

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Objectives: To identify clinical and morphological biomarkers associated with early onset of large submacular hemorrhage (SMH) secondary to neovascular age-related degeneration (nAMD) after anti-vascular endothelial endothelial growth factor (anti-VEGF) intravitreal injection (IVI). Methods: We retrospectively included patients presenting large SMH secondary to treated nAMD, for which at least 2 examinations, including spectral-domain optical coherence tomography (SD-OCT), were available prior to the onset of the SMH. Clinical characteristics, cardiovascular risk factors and treatment, as well as SD-OCT qualitative and quantitative variables were extracted at the 2 last examinations before SMH onset. History of previous SMH on the fellow eye was also documented. Early SMH onset at defined as <45 days versus > 45 days since last IVI were compared. Results: Forty-six eyes of 46 patients were included in this study, of which 93% were undergoing pro-re-nata regimen with a monthly follow-up. Onion sign, persistence of exudative signs and increasing height of PED between the two last SD-OCT were associated with early SMH onset following last IVI. SMH was bilateral for 41% patients (19/46). In case of history of SMH on the fellow eye, the pre-existence of a RPE-tear before second SMH was significantly higher (p=0.029) in comparison to unilateral SMH. Conclusion: Persistence of exudative signs,, onion sign and increasing PED height despite anti-VEGF intravitreal injections between the two last examination, as well presence of RPE tear in case of history of an SMH on the fellow eye, should be considered as warning signs for SMH.

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Section: Discussionsupporting

confidence: 92%

Biomarkers associated with early onset of large submacular hemorrhage secondary to neovascular age-related macular degeneration after anti-VEGF intravitreal injection

Zegrari¹,

Cohen²,

Colantuono

et al. 2023

Preprint

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“…Bevacizumab is a full-length monoclonal antibody (149 kDa) that was developed for cancer therapy 7. Repetitive intravitreal injections can lead to a severe economic burden and an increased risk of infection, and thus, many clinical trials have been conducted to identify an optimal therapeutic strategy 8,9. There are significant inter-individual differences in response to an anti-VEGF agent.…”

Section: Introductionmentioning

confidence: 99%

<p>The cGAS/STING pathway: a sensor of senescence-associated DNA damage and trigger of inflammation in early age-related macular degeneration</p>

Wu¹,

Wei²,

Yu³

2019

CIA

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Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among the elderly. Considering the relatively limited effect of therapy on early AMD, it is important to focus on the pathogenesis of AMD, especially early AMD. Ageing is one of the strongest risk factors for AMD, and analysis of the impact of ageing on AMD development is valuable. Among all the ageing hallmarks, increased DNA damage accumulation is regarded as the beginning of cellular senescence and is related to abnormal expression of inflammatory cytokines, which is called the senescence-associated secretory phenotype (SASP). The exact pathway for DNA damage that triggers senescence-associated hallmarks is poorly understood. Recently, mounting evidence has shown that the cGAS/STING pathway is an important DNA sensor related to proinflammatory factor secretion and is associated with another hallmark of ageing, SASP. Thus, we hypothesized that the cGAS/STING pathway is a vital signalling pathway for early AMD development and that inhibition of STING might be a potential therapeutic strategy for AMD cases.

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“…Prior studies demonstrated mixed results in the association of anticoagulation use with hemorrhage. Some studies found no association; 11 however, a subanalysis of CATT (Comparison of Age-related AMD Treatments Trials) participants found increased hemorrhage rates in patients on anticoagulation who were also hypertensive. 12 Our cohort was far too small to draw meaningful implications of hemorrhage extent or presence with anticoagulation; however, like the presence of prior hemorrhage, it is likely prudent to denote concurrent use of anticoagulation in the medical record to facilitate patient-physician discussion and appointment triage.…”

Section: Discussionmentioning

confidence: 99%

Choroidal Neovascularization and Macular Hemorrhage: Real-World Experience During the New York City COVID-19 Lockdown

Kovacs

González

Mahrous

et al. 2021

Journal of VitreoRetinal Diseases

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Purpose: This work reviews ocular, systemic, and demographic factors contributing to presentation of choroidal neovascular membrane (CNVM)–associated macular hemorrhage after the New York City coronavirus disease 2019 (COVID-19) lockdown. Methods: A retrospective, consecutive case series was conducted of all established patients presenting with macular hemorrhage between March 22, 2020, and August 10, 2020. Results: Fourteen patients (mean age 82.2 years) were evaluated. Ten patients had active CNVMs, 1 had an inactive lesion that was last injected 2 years prior, and 3 had new conversions from nonexudative age-related macular degeneration. In the actively treated CNVM group there was a delay in expected follow-up from 50.4 days to 125 days. Eight patients with previously active CNVM (73%) had a history of prior macular hemorrhage. Eight patients (57%) were on some form of antiplatelet or anticoagulation therapy. Twelve patients (86%) had COVID-19–specific risk factors besides age, and all but 1 patient (93%) delayed care without discussion with a physician. Ten patients (71%) had more than 1 week of symptoms prior to presentation. Twelve patients (86%) had signs of CNVM on prior optical coherence tomography. Conclusions: Adequate documentation of potential risks for hemorrhage (particularly prior hemorrhage or presence of subclinical type 1 CNVM), as well as COVID-19–specific risk factors, would aid triage of clinic appointments in future lockdowns. High-risk patients would likely benefit from direct physician communication discussing their individual risk profiles to alleviate anxiety over clinic visits and communicate their risk of severe vision loss.

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Antiplatelet and Anticoagulant Drugs Do Not Affect Visual Outcome in Neovascular Age-Related Macular Degeneration in the BRAMD Trial

Cited by 15 publications

References 35 publications

Biomarkers associated with early onset of large submacular hemorrhage secondary to neovascular age-related macular degeneration after anti-VEGF intravitreal injection

Biomarkers associated with early onset of large submacular hemorrhage secondary to neovascular age-related macular degeneration after anti-VEGF intravitreal injection

<p>The cGAS/STING pathway: a sensor of senescence-associated DNA damage and trigger of inflammation in early age-related macular degeneration</p>

Choroidal Neovascularization and Macular Hemorrhage: Real-World Experience During the New York City COVID-19 Lockdown

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