Abstract Introduction Venous Thromboembolism (VTE), clinically presenting as Pulmonary Embolism (PE) or Deep Vein Thrombosis (DVT), is a life-threatening condition with PE accounting for approximately 100,000 deaths each year in the United States. There are established, extensive predisposing environmental and genetic risk factors for VTE, usually linked to immobility, malignancy, or thrombophilia. However, iatrogenic PE following intraocular drug injection is exceedingly rare and seldom reported in the literature. Recent reports suggest that intravitreal anti-vascular endothelial growth factor(VEGF) agents may have systemic prothrombotic effects by suppressing circulating VEGF levels. Description We report the case of an 87-year-old female with macular degeneration, presenting with acute confusional state and hypoxia due to a saddle PE and DVT associated with acute hypoxemic respiratory failure following recent intraocular injection of Bevacizumab. Other comorbidities include hypertension, subclinical hypothyroidism, and asthma. She required ICU admission for hypoxia, atrial flutter with tachycardia, and encephalopathy. Initial laboratory data revealed elevations in lactate, BNP, and troponin, leukocytosis, and renal dysfunction with oliguria. Lower extremity Doppler ultrasound demonstrated acute left DVT, and anticoagulation with intravenous heparin was initiated. Echocardiography showed right heart strain and McConnell’s sign. Following premedication before contrast exposure due to iodine allergy, the chest CT angiogram done showed saddle PE, right heart strain, and lung infarct. Despite oxygen supplementation via high-flow nasal cannula and BiPAP, her respiratory distress worsened, necessitating intubation and mechanical ventilation. Following multidisciplinary discussions with Cardiothoracic Surgery, Cardiology, Interventional Radiology, and Critical Care, she received half-dose systemic thrombolysis (tPA) with noted rapid hemodynamic and respiratory improvement within 24 hours, resulting in successful extubation to a nasal cannula. Repeat echocardiogram showed improvement in right heart strain with resolution of the McConnell sign. She was transitioned to apixaban and discharged to a skilled nursing facility with pulmonary outpatient follow-up. Discussion This case underscores a rare yet plausible link between intraocular anti-VEGF injection and venous thromboembolism, potentially driven by systemic VEGF suppression and endothelial dysfunction. Avery et al. demonstrated that intravitreal bevacizumab can reduce circulating VEGF levels, which may alter vascular homeostasis and promote thrombus formation. The close temporal relationship between the ocular injection and the patient’s VTE, combined with the absence of traditional risk factors, suggests a causal association.This case seeks to increase awareness amongst physicians and vigilance in monitoring and managing patients receiving intra-ocular bevacizumab and other monoclonal antibodies to VEGF of potential adverse systemic complications, including PE. This abstract is funded by: None
Ikwu et al. (Fri,) studied this question.