Branch retinal artery occlusion in the untreated contralateral eye following aflibercept injections during heparin treatment: Possible contribution of a heparin-induced thrombocytopenia-like condition

Abstract

Purpose In this study, we report a case of branch retinal artery occlusion (BRAO) in the contralateral eye the day after aflibercept treatment during systemic heparin administration. Observations A 63-year-old woman with diabetic macular edema underwent repeated intravitreal injection of anti-VEGF drugs (0.5mg ranibizumab or 2mg aflibercept) for her left eye. The day after intravitreal injection of aflibercept, she presented with sudden painless blurred vision that was limited to the inferior visual field defect in the contralateral eye (right eye) during hemodialysis with the anti-coagulant heparin. Optical coherence tomography angiography (OCTA) showed decreased artery perfusion and the patient was diagnosed with contralateral BRAO. Conclusions Previous in vitro and in vivo studies have reported that the Fc portion of anti-VEGF drugs activates platelets with heparin. Therefore, careful anti-VEGF drug selection may be necessary in cases with concomitant heparin treatment.

Medications Damaging Vascular Bed or Causing Microvasculopathy / Occlusion-2: Pathogenesis, Diagnosis, and Treatment (Gemcitabine, Fludarabine, Oral contraceptives, Heparin, Cocaine)

“…bildirdikleri olgu sunumunlarında heparinli diyalize giren ve diyabetik makula ödemi nedeniyle aflibercept uygulanan hastanın tedavi edilmeyen gözünde enjeksiyon sonrası birinci günde retinal arter dal tıkanıklığı tespit etmişler ve patogenezde HİT'yi sorumlu tutmuşlardır (Resim 3). [37] Heparin ile indüklenmiş trombositopeniyi sistemik enfeksiyon ve kullanılan ilaçlar nedeniyle ortaya çıkan trombositopeniden ayırmak çok önemlidir. Trombositopeni olgularının sadece %5 kadarını HİT olguları oluşturmaktadır.…”