Low‐dose aspirin and prevention of cranial ischemic complications in giant cell arteritis

Abstract

Objective. Cranial ischemic complications such as cerebrovascular accidents (CVAs) and acute visual loss are among the leading causes of giant cell arteritis (GCA)-related morbidity. In this retrospective study, we evaluated the effect of treatment with low-dose aspirin on the incidence of cranial ischemic complications in GCA.Methods. Charts of 175 consecutive patients in whom GCA was diagnosed between 1980 and 2000 were reviewed for medical data. Data for 166 patients who were followed up for at least 3 months were also available.Results. At the time of the diagnosis of GCA, 36 patients (21%) had already been receiving low-dose aspirin (100 mg/day). In all cases, the indication for this treatment was ischemic heart disease. There were no significant differences between the aspirin-treated and non-aspirin-treated groups regarding the mean age of patients, the male-to-female ratio, duration of GCArelated symptoms, rates of headaches, systemic symptoms, and jaw claudication, and the mean erythrocyte sedimentation rate, hemoglobin count, and platelet count. Cerebrovascular risk factors (hypertension, hyperlipidemia, or diabetes mellitus) were more common in the aspirin-treated group (38.9% versus 20%; P‫؍‬ 0.03). Cranial ischemic complications were diagnosed in 43 patients at presentation: 30 patients had acute visual loss, 11 had CVAs, and 2 had both conditions simultaneously. Only 3 of the aspirin-treated patients (8%) presented with cranial ischemic complications, compared with 40 (29%) of the non-aspirin-treated patients (P ‫؍‬ 0.01). Despite the use of steroid therapy, cranial ischemic complications developed in 14 of the 166 patients followed up for 3 months or longer. However, cranial ischemic complications developed in only 3% of the aspirin-treated patients, compared with 13% of the patients treated with prednisone only (P ‫؍‬ 0.02).Conclusion. These data suggest that low-dose aspirin decreases the rate of visual loss and CVAs in patients with GCA.

PlA1/A2 polymorphism of the platelet glycoprotein receptor IIIA and risk of cranial ischemic complications in giant cell arteritis

“…Two recent studies from tertiary care centers have demonstrated that antiplatelet therapy may reduce the risk of cranial ischemic complications in patients with GCA (9,10). The present population-based study did not confirm those results.…”

“…Although ischemic damage in GCA is usually attributed to occlusive vasculopathy caused by intimal proliferation, a possible role of thrombosis in causing cranial ischemic complications cannot be excluded (7,8). Low-dose aspirin or anticoagulant therapy has been shown to reduce the risk of visual loss and CVAs in patients with GCA (9,10). The benefits of low-dose aspirin in GCA could derive from the antiplatelet effect of aspirin, although its antiinflammatory action may also be involved (11).…”

Endothelial nitric oxide synthase gene polymorphisms in giant cell arteritis

“…Although this finding requires further confirmation in other populations, it is potentially important because it implies that a genetically determined endothelial dysfunction may predispose individuals to this vasculitis. Interestingly, pilot studies have found that low-dose aspirin and the anti-tumor necrosis factor ␣ antibody infliximab may improve the efficacy of corticosteroid treatment of GCA (32,33). In addition, 2 recent studies have demonstrated improved endothelial function using these 2 drugs (34,35).…”

Concise guidance: diagnosis and management of giant cell arteritis

“…Low-dose aspirin has also been shown to decrease the rate of visual loss and cerebrovascular accidents in GCA. 4 In recurrent or resistant GCA, methotrexate or other immunosuppressives (eg azathioprine or leflunomide) may be used as adjuvant therapy to allow reduction in the cumulative glucocorticosteroid dose, or a higher probability of glucocorticosteroid discontinuation without relapse. 5 …”