title: Systemic thromboembolic adverse events in patients treated with intravitreal anti-VEGF drugs for neovascular age-related macular degeneration: an overview.
abstract: BACKGROUND
  Anti-VEGF therapy improved the quality of life for millions of patients suffering from wet age-related macular degeneration (wet-AMD); unfortunately, this therapy involves multiple injections over many years. The administration of anti-VEGF can overcome the blood-retinal barrier with agents entering the systemic circulation and causing a significant decrease in VEGF serum concentration. Although circulating VEGF protects the integrity and patency of vessels, prolonged anti-VEGF treatment has the potential to increase the risk of thromboembolic events.
  
  
  METHODS
  In this review, we discuss the safety data from recent trials involving available anti-VEGF drugs.
  
  
  CONCLUSIONS
  During the 2 years of follow-up in the relevant clinical trials, the rates of serious adverse events such as stroke, heart attack and death were similar for patients treated with different anti-VEGF drugs. Moreover the arterial thrombotic risk appears sufficiently low when compared with the natural incidence of arterial thrombotic events in this category of elderly patients and acceptably balanced against the advantage of improved vision. Since the use of these drugs is likely to become increasingly widespread and prolonged, it is desirable that the scientific community improves the pharmacovigilance program on all anti-VEGF drugs, expanding knowledge with studies that compares head to head all four compounds belonging to anti-VEGF armamentarium.
authors.affiliation: University of Brescia, Spedali Civili di Brescia, Radiological Specialties and Public Health, Ophthalmology Clinic, Department of Medical and Surgical Specialties , Piazzale Spedali Civili 1, 25123 Brescia , Italy +39 0303995308 ; +39 0303388191 ; sarah.duse@alice.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Semeraro
authors.forename: Francesco
authors.initials: F
authors.lastname: Morescalchi
authors.forename: Sarah
authors.initials: S
authors.lastname: Duse
authors.forename: Elena
authors.initials: E
authors.lastname: Gambicorti
authors.forename: Mario R
authors.initials: MR
authors.lastname: Romano
authors.forename: Ciro
authors.initials: C
authors.lastname: Costagliola
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D058449:Intravitreal Injections; D060735:Pharmacovigilance; D011788:Quality of Life; D012306:Risk; D013923:Thromboembolism / Q000139:chemically induced* / Q000453:epidemiology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D057135:Wet Macular Degeneration / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A
keywords: aflibercept; age-related macular degeneration; anti-VEGF; bevacizumab; hypertension; myocardial infarction; pegaptanib; ranibizumab; side effects; stroke