Thorel J, Civade E, Quintyn J C, Cestac P, Montastruc J-L, Bagheri H
Department of Pharmacy, Toulouse University Hospital, Toulouse, France.
Department of Ophthalmology, Toulouse University Hospital, Toulouse, France.
J Clin Pharm Ther. 2015 Aug;40(4):477-9. doi: 10.1111/jcpt.12278. Epub 2015 Apr 30.
Vascular endothelial growth factor (VEGF) proteins are involved in the regulation of vascular endothelium, and their inhibition led to the development of a number of drugs used for malignancies or exudative neo-vascular age-related macular degeneration (AMD).
We report a case of ischemic stroke in an 87-year-old woman having received intravitreal aflibercept, a new anti-VEGF for AMD. She had been treated with ranibizumab since 2007. In 2013, ranibizumab was replaced with aflibercept, followed by a decrease in the International Normalized Ratio, complicated by a stroke a few days later. The rechallenge was positive.
A potential time-dependent interaction between aflibercept and VKA antagonist and/or a direct effect of aflibercept may have contributed to the occurrence of the ischaemic stroke. Currently available data suggest some pharmacokinetic and pharmacodynamic effects of aflibercept by explaining its pro-thrombotic profile.
