Blood coagulation parameters after intravitreal injection of aflibercept in patients with neovascular age-related macular degeneration

Abstract

IVA may cause a decrease in the levels of PT and aPTT at 1 month after the first injection and 1 month after the second injection although these results are not statistically significant in our study.

Evaluation of Blood Coagulation Parameters and ADMA, NO, IL-6, and IL-18 Serum Levels in Patients with Neovascular AMD before, during, and after the Initial Loading Phase of Intravitreal Aflibercept

“…To date, four studies assessing the influence of intravitreal injections of anti-VEGF agents on the coagulation parameters have been published [ 9 , 13 , 20 , 21 ]. In patients with proliferative diabetic retinopathy (PDR), the effect of IVB on prothrombin time was evaluated [ 13 ], while another study evaluated clotting time, serum fibrinogen level, and blood viscosity in patients with CNV treated with IVR [ 9 ].…”

“…In patients with proliferative diabetic retinopathy (PDR), the effect of IVB on prothrombin time was evaluated [ 13 ], while another study evaluated clotting time, serum fibrinogen level, and blood viscosity in patients with CNV treated with IVR [ 9 ]. In the third study, changes in APTT and PT were measured in patients with nAMD who received IVA [ 20 ]. Georgakopoulos et al assessed the effect of IVA on platelet count, PT, APTT, and fibrinogen, D-dimer, and protein C and S levels in the serum of patients with AMD [ 21 ].…”

“…Georgakopoulos et al assessed the effect of IVA on platelet count, PT, APTT, and fibrinogen, D-dimer, and protein C and S levels in the serum of patients with AMD [ 21 ]. Altinkaynak et al revealed a decrease in APTT and PT values both one month after the first IVA injection and one month after the second injection in patients with nAMD; however, in both measurement points the results were not statistically significant [ 20 ]. The results of other study showed a significant reduction in APTT and an increase in the low, medium, and high serum shear rate measured after the first week of IVR injection in patients with CNV compared to the control group; this difference was not demonstrated a month after the first and or a month after the second IVR administration.…”

Changes of plasma nitric oxide, endothelin-1, and blood coagulation following intravitreal conbercept

“…We hypothesize that the causes may be multifaceted including specific drug related blood chemistry changes and patients’ health conditions. A few studies have looked into the blood coagulation parameters following intravitreal injection of bevacizumab 14 or aflibercept 9 , 10 or ranibizumab 12 . In contrast, so far there is no similar report following intravitreal conbercept.…”

“…For the second part of the hypothesis regarding possible subsequent changes of the blood coagulation system and the underneath mechanism, scientific data is very scarce and heterogeneous in literature. A few studies have investigated blood coagulation parameters after intravitreal injection of aflibercept 9 – 11 ranibizumab 12 , 13 or bevacizumab 13 , 14 ; however, the results are variable. With low event rate of the systemic adversary and possible drug specific difference or difference of patient condition, a large sample from a real-world practice would be preferable to approach the possible hidden connection between use of intravitreal anti-VEGF and changes of systemic coagulation.…”