RT Journal Article SR Electronic T1 Aortic dissection after ramucirumab infusion JF European Journal of Hospital Pharmacy JO Eur J Hosp Pharm FD British Medical Journal Publishing Group SP 117 OP 120 DO 10.1136/ejhpharm-2019-001879 VO 27 IS 2 A1 Davide Zenoni A1 Flavio Niccolò Beretta A1 Vanessa Martinelli A1 Alessandro Iaculli A1 Maria Teresa Benzoni Fratelli A1 Delia Bonzi YR 2020 UL http://ejhp.bmj.com/content/27/2/117.abstract AB A female patient in her seventies affected by a signet-ring cell carcinoma G3pT4N3 (24/29), with lymphovascular invasion, HER2-negative. After completing three cycles of first-line systemic treatment in combination with cisplatin (CDDP) + 5-fluorouracil (5FU), a new systemic therapy line with paclitaxel + Cyramza (ramucirumab) was planned. On the day after the first administration the patient manifested a Standford type A aortic dissection (AD), with a diameter of around 6.5 cm and dissection flap originating in the ascending aorta below the brachiocephalic trunk, extended to the whole descending aorta until the carrefour.The causal relationship between adverse drug reactions and Cyramza, calculated using the Naranjo algorithm, led to a result of 'probable' correlation between ramucirumab and AD. The endothelial dysfunction associated with vascular endothelial growth factor pathway inhibitors (VPIs) would seem to be the most plausible explanation for such events: it causes thromboembolic events and cardiovascular complications.