Annual Rates of Arterial Thromboembolic Events in Medicare Neovascular Age-Related Macular Degeneration Patients

Alexander, Sherri L; Linde-Zwirble, Walter T.; Werther, Winifred; Depperschmidt, Eric E.; Wilson, Laura J.; Palanki, Ram; Saroj, Namrata; Butterworth, Sara L.; Ianchulev, Tsontcho

doi:10.1016/j.ophtha.2007.09.017

Cited by 72 publications

(57 citation statements)

References 31 publications

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“…Liao et al reported that neovascular AMD was associated with higher adjusted 2-year incidence of stroke (8.15% versus 6.35%; OR 1.31, 95% CIϭ1.26 to 1.36), 13 but Alexander et al reported that Medicare beneficiaries with neovascular AMD had an annual rate of inpatient ischemic stroke similar to that of matched control subjects (3.5% versus 3.6%). 11 Based on a representative database and sufficient neovascular AMD case numbers (Nϭ209), our results are compatible with most previous reports, supporting an association between neovascular AMD and a higher incidence of stroke. There are several possible mechanisms for the association between AMD and stroke, including atherosclerosis, inflammation, and genetic factors.…”

Section: Discussionsupporting

confidence: 91%

“…10 Moreover, US Medicare beneficiaries with neovascular AMD had a rate of inpatient ischemic stroke similar to that of matched control subjects. 11 However, in the Blue Mountains Eye Study (BMES), Tan et al reported that late AMD predicted 10-fold higher stroke mortality in people Ͻ75 years of age. 12 Whether late AMD is related to stroke is thus still unproven.…”

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confidence: 99%

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Neovascular Age-Related Macular Degeneration and the Risk of Stroke

Lin

2010

Stroke

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Background and Purpose-Using a nationwide population-based data set from Taiwan, this study investigated the relationship between neovascular age-related macular degeneration (AMD) and the risk of stroke over a 5-year period. Method-The study cohort comprised 209 patients who received treatment for AMD between 1999 and 2001. We randomly selected 1045 subjects matched with the study cohort in terms of age and gender for comparison. Cox proportional hazard regressions were performed to compare the 5-year stroke-free survival rate. Results-Among the sampled patients, 142 patients (11.3%) had strokes during the 5-year follow-up period, 38 (18.2% of the patients with AMD) from the study cohort and 104 (9.9% of patients in the comparison cohort) from the comparison cohort. After adjusting for the patient's age, gender, monthly income, level of urbanization, and the geographic region of the community in which the patient resided and comorbidities, the hazard ratio for stroke during the follow-up period was 2.01 (Pϭ0.001) times greater for patients with AMD than for patients without AMD. The adjusted hazard ratio for stroke during the follow-up period was 2.21 (Pϭ0.001) times higher for patients with AMD Ն65 years old compared with the same age group in the comparison cohort. However, no significant difference was observed in the risk of stroke between patients with AMD Ͻ65 years of age and comparison patients in the same age group. Conclusion-We conclude that neovascular AMD is associated with a higher risk of stroke for patients with AMD Ն65 years old. (Stroke. 2010;41:613-617.)

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Neovascular Age-Related Macular Degeneration and the Risk of Stroke

Lin

2010

Stroke

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“…The sustained reduction in VEGF plasma levels in an old population with multiple co-morbidities and high cardiovascular risk such as patients with exudative AMD can increase the risk of thromboembolic events in those receiving anti-VEGF therapies (Alexander et al 2007;Csaky & Do 2009;Carneiro et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Vascular endothelial growth factor plasma levels before and after treatment of neovascular age‐related macular degeneration with bevacizumab or ranibizumab

Carneiro

Costa

Falcão

et al. 2011

Acta Ophthalmologica

135

107

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. Purpose: To evaluate the changes of vascular endothelial growth factor (VEGF) plasma levels after intravitreal injections of ranibizumab or bevacizumab in patients with exudative age‐related macular degeneration (AMD). Methods: Forty‐three patients with exudative AMD and 19 age‐ and sex‐matched control patients without chorioretinal diseases were studied. Nineteen patients were treated with intravitreal ranibizumab 0.5 mg, 24 with intravitreal bevacizumab 1.25 mg. Blood samples were collected just before the first injection, and 28 days after three initial consecutive injections performed in 4‐weekly intervals (loading dose). Concentration of VEGF in the plasma was measured by ELISA. Results: At baseline, the median VEGF concentrations in controls were 180.97 pg/ml, in the bevacizumab group 189.72 pg/ml and in the ranibizumab group 191.36 pg/ml. VEGF plasma concentrations in patients with wet AMD were comparable to controls (p = 0.225). Twenty‐eight days after the third injection, a significant reduction of 42% in the median VEGF plasma levels was found in bevacizumab‐treated patients (109.97 pg/ml; p = 0.0002) but not in ranibizumab‐treated patients (189.97 pg/ml; p = 0.198) where a reduction of 0.7% in the median value was found. Conclusions: Intravitreal bevacizumab significantly reduced VEGF plasma levels until 28 days after intravitreal injection in patients with exudative AMD. Ranibizumab did not achieve a significant plasma VEGF reduction at the same time‐point. These findings alert to the potential systemic safety differences between the two drugs after intravitreal administration.

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“…However, those recorded were at a level expected for patients with AMD in this age group. 12 The study has obvious limitations. It is a retrospective study, evaluating only patients who have returned for follow-up.…”

Section: Discussionmentioning

confidence: 99%