Abstract
Objective: To determine the effectiveness of antiplatelet and/or anticoagulant therapy (AP/AC) at reducing ischemic events in patients with Large Vessel Vasculitis (LVV). Methods: We performed a random effects meta-analysis of studies examining antiplatelet and/or anticoagulant therapy (AP/AC) and ischemic events in Takayasu’s Arteritis (TAK) or Giant Cell Arteritis (GCA). Severe ischemic events were defined as stroke, ischemic ocular manifestations and claudication symptoms. Any ischemic event included jaw claudication in addition to the above manifestations. Results: Seven studies met inclusion criteria: 1 TAK and 6 GCA. The majority of patients (>80%) were treated with ASA and treatment was initiated prior to diagnosis of LVV. Risk of severe and any ischemic event in patients with LVV treated with AP/AC versus no treatment was not significantly different (OR 0.570, 95% CI 0.243, 1.340 and OR 0.594, 95% CI 0.248, 1.421, respectively). For studies with follow-up data (26-76 months), AP/AC was protective for severe ischemic events (OR 0.18, 95% CI 0.04, 0.83). Findings were similar when excluding studies that did not account for potential confounders, such as cardiovascular risk factors. Conclusion: At follow-up, antiplatelet therapy significantly decreases ischemic events in patients with LVV. However, in most cases of GCA, the treatment was initiated prior to the diagnosis of vasculitis. The benefit of initiating anti-platelet therapy at the time of GCA diagnosis remains unclear.
Highlights
Large Vessel Vasculitis (LVV) refers to a rare condition of systemic inflammation with involvement of large and medium sized blood vessels
Random effects meta-analysis (DerSimonian and Laird method) was performed to determine the primary outcome: risk of severe ischemic events in patients treated with AP/AC versus those not treated with AP/AC expressed as an odds ratio (OR)
Mean differences in ORs for any ischemic event were not significantly affected by percentage of participants with cardiovascular risk factors, platelet count, or baseline ESR, but analyses were limited by small sample size. This is the first meta-analysis to examine the efficacy of antiplatelet and/or anticoagulant therapy (AP/AC) in preventing ischemic events in Large Vessel Vasculitis
Summary
Large Vessel Vasculitis (LVV) refers to a rare condition of systemic inflammation with involvement of large and medium sized blood vessels. GCA affects patients over the age of 50 and affects women more often than men while TAK typically affects women under the age of 40 and has a predisposition for people of Asian descent [1] [2]. The incidence of both conditions is rare: 100 - 250 per million for GCA and 2.6 per million for TAK [1]-[3]. TAK typically affects large arteries especially the aorta and may manifest as regional pain over the affected area Less commonly it results in TIA, stroke, myocardial infarction (MI), and visual symptoms [14]-[16]
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