Do Anti-VEGF Eye Treatments Increase Bleeding Risk?

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Anti-VEGF (vascular endothelial growth factor) medications are very effective in treating age-related macular degeneration, diabetic macular edema, and retinal vein occlusion (blockage of the small veins that carry blood away from the retina). But there has long been concern that they may increase the risk of bleeding and other problems.

To assess how real that risk is, French researchers reviewed findings from 21 studies published between 2011 and 2016. The studies included data on four anti-VEGF medications: ranibizumab, bevacizumab, aflibercept, and pegaptanib. Although some individual studies found increased risks, others didn’t.

The meta-analysis, published in JAMA Ophthalmology in May 2018, found that when all the results were analyzed, anti-VEGF treatments were not associated with a significantly higher risk of bleeding. That finding was true for both monthly and as-needed anti-VEGF treatments.

That’s good news for patients who can benefit from this vision-sparing medicine. But this study had limitations. The scientists did not have access to the raw data from the studies they reviewed. Given the design of the studies under review, they couldn’t determine if dose or duration of treatment affected any potential risk. And there may be risks for particular anti-VEGF medications in certain people. For example, ranibizumab was associated with an increase in the risk of non-eye-related hemorrhage in patients with age-related macular degeneration, the researchers found.

As always, it’s important to talk over your treatment choices with your doctor.

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