Embolic stroke immediately after initial administration of intravitreal aflibercept

Abstract

A 72-year-old man was admitted to our hospital because of right upper limb monoplegia 8 hours after the initial intravitreal injection of aflibercept, which is an inhibitor of vascular endothelial growth factor. Magnetic resonance diffusion-weighted images showed recent ischemic lesions in the left corona radiata and the right superior frontal gyrus. Laboratory findings showed mild hyperfibrinolysis. A patent foramen ovale was diagnosed on transesophageal echocardiography; however, lower-extremity ultrasonography did not detect deep vein thrombosis. The source of embolism remained unknown. A possible mechanism of cerebral emboli in the present case was a rapidly induced hypercoagulative state due to transfer of aflibercept from the vitreous body to the systemic circulation.

Transient Ischemic Attack and Hypoventilation 12 Hours After Intra-vitreal Aflibercept Injection

“…Although a limited number of case reports described thromboembolic event post aflibercept use, this is the first case reporting a possible association between aflibercept, TIA, and hypoventilation given the negative result of all investigations [19][20]. Moreover, apart from this potential link between aflibercept and TIA, a synergetic effect of aflibercept to the atherosclerotic consequences of age, diabetes mellitus and hypertension may have contributed to the occurrence of the ischemic event in our patient.…”