An 82-year-old man with wet AMD and a history of ischemic stroke six weeks ago requires intravitreal anti-VEGF therapy. His physician counsels him about the principal systemic concern with these agents, which is:

• A Hepatic failure from hepatic clearance of the antibody fragment
• B Arterial thromboembolic events including recurrent stroke and myocardial infarction ✓
• C Permanent renal impairment from proteinuria
• D Bone marrow suppression requiring regular blood counts

Explanation

Systemic VEGF inhibition can impair vascular repair and endothelial integrity, so intravitreal anti-VEGF agents carry a small but real risk of arterial thromboembolic events such as cerebrovascular accident and myocardial infarction, particularly in patients with recent cardiovascular events. Hepatotoxicity, nephrotoxicity, and marrow suppression are not recognized systemic risks of intravitreal anti-VEGF dosing.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.