Systemic Arterial and Venous Thrombotic Events Associated with Anti-Vascular Endothelial Growth Factor Injections: A Meta-Analysis

PURPOSE: To compare the risk of systemic arteriovenous thrombotic events between intravitreal antivascular endothelial growth factor (anti-VEGF) and sham injections. DESIGN: Random-effects meta-analysis. METHODS: A systematic search was performed on OVID MEDLINE, Embase, and Cochrane Library from January 2005 to August 2023. Our inclusion criteria were randomized controlled trials (RCTs) reporting on systemic arteriovenous events for standard dose intravitreal anti-VEGF agents for any indication. RESULTS: A total of 20 RCTs reporting on 12,833 eyes were included. There was no significant difference in the risk of any thrombotic event between bevacizumab 1.25 mg and ranibizumab 0.5 mg (Risk ratio (RR) = 0.96, 95% CI = 0.52-1.75, P = . 89). There was no significant difference between bevacizumab and ranibizumab when restricting to arterial thrombotic events (RR = 0.88, 95% CI = 0.60-1.30, P = . 53) or venous thrombotic events (RR = 1.99, 95% CI = 86 0.68-5.82], P = . 21). The risk of arterial thrombotic events was similar between aflibercept and bevacizumab (RR = 1.11, 95% CI = 0.60-2.07, P = . 74), between aflibercept and ranibizumab (RR = 0.77, 95% CI = 0.49-1.21, P = . 26), between brolucizumab and aflibercept (RR = 0.67, 95% CI = 0.321.38, P = . 27), and between aflibercept and faricimab (RR = 0.96, 95% CI = 0.43-2.17, P = .93). Compared to sham, neither dose of ranibizumab (0.5 mg or 0.3 mg) showed a higher risk of arterial thrombotic events. CONCLUSIONS: There was a similar risk of systemic arteriovenous thrombotic adverse events between anti VEGF agents and between ranibizumab and sham injections.