Serum D-dimer levels to evaluate the risk for arterial thromboembolism after intravitreal injection of bevacizumab and ranibizumab.

PURPOSE: There are concerns about arterial thromboembolic event after intravitreal injection of bevacizumab or ranibizumab. Motivated by the fact that D-dimer was a sensitive biomarker for thromboembolism, we evaluated serum D-dimer levels in patients with age-related macular degeneration (AMD) after intravitreal injection of bevacizumab and ranibizumab.

METHODS: In this prospective, nonrandomized, uncontrolled study, 122 patients (122 eyes) with AMD were enrolled. Sixty-two eyes received intravitreal injections of bevacizumab and 60 eyes received intravitreal injections of ranibizumab monthly for 3 months. Serum D-dimer levels were measured in patients before intravitreal injection and 1 day, 1 week, 1 month, and 3 months thereafter.

RESULTS: Serum D-dimer levels were not significantly altered following injection of either bevacizumab or ranibizumab. Subgroup analysis for patients at risk for thromboembolic events revealed that serum D-dimer levels showed no significant change after injection of ranibizumab. However, D-dimer levels significantly increased at 1 day (P=0.041) and 1 week (P=0.022) after injection of bevacizumab.

CONCLUSIONS: Serum D-dimer levels were not changed after injection with either bevacizumab or ranibizumab. In subgroup analysis, bevacizumab injection in patients at risk of thromboembolism increased serum D-dimer levels.