Lee Michael S, Smith Scott D, Galor Anat, Hoffman Gary S
University of Minnesota, Minneapolis, USA.
Arthritis Rheum. 2006 Oct;54(10):3306-9. doi: 10.1002/art.22141.
Vision loss and cerebrovascular accidents often complicate giant cell arteritis (GCA). Antiplatelet and anticoagulant therapy reduce the risk of stroke in other populations. We sought to determine whether antiplatelet or anticoagulant therapy reduces ischemic complications in patients with GCA.
A retrospective chart review for patients with GCA was conducted. Included patients fulfilled modified 1990 American College of Rheumatology criteria for GCA. Collected information included demographic data, dates of antiplatelet or anticoagulant use, vision loss or stroke, and presence of bleeding complications and cerebrovascular risk factors.
A total of 143 patients were included with a mean followup period of 4 years. The cohort included 109 women (76%) and 34 men (24%) with a mean age of 71.8 years. A total of 104 patients (73%) had a biopsy-proven diagnosis. Eighty-six patients (60.1%) had received long-term antiplatelet or anticoagulant therapy, including 18 (12.6%) who did not start therapy until after an ischemic event had occurred. Antiplatelet agents or anticoagulants were not used in 57 patients (39.9%). Overall, 11 of 68 patients (16.2%) had an ischemic event while receiving antiplatelet or anticoagulant therapy, compared with 36 of 75 patients (48.0%) not receiving such therapy (P < 0.0005). Univariate analysis failed to show a statistical difference between groups in regard to cerebrovascular risk factors, age, sex, or biopsy-proven diagnosis. Bleeding complications occurred in 2 patients receiving aspirin, 1 patient receiving warfarin, and 5 patients who did not receive anticoagulant or antiplatelet therapy.
Antiplatelet or anticoagulant therapy may reduce the risk of ischemic events in patients with GCA. An increased risk of bleeding complications was not observed.
视力丧失和脑血管意外常使巨细胞动脉炎（GCA）病情复杂化。抗血小板和抗凝治疗可降低其他人群的中风风险。我们试图确定抗血小板或抗凝治疗是否能降低GCA患者的缺血性并发症风险。
对GCA患者进行回顾性病历审查。纳入的患者符合1990年美国风湿病学会修订的GCA标准。收集的信息包括人口统计学数据、抗血小板或抗凝药物使用日期、视力丧失或中风情况、出血并发症和脑血管危险因素的存在情况。
共纳入143例患者，平均随访期为4年。该队列包括109名女性（76%）和34名男性（24%），平均年龄为71.8岁。共有104例患者（73%）经活检确诊。86例患者（60.1%）接受了长期抗血小板或抗凝治疗，其中18例（12.6%）直到发生缺血事件后才开始治疗。57例患者（39.9%）未使用抗血小板药物或抗凝剂。总体而言，68例接受抗血小板或抗凝治疗的患者中有11例（16.2%）发生缺血事件，而75例未接受此类治疗的患者中有36例（48.0%）发生缺血事件（P<0.0005）。单因素分析未显示两组在脑血管危险因素、年龄、性别或活检确诊方面存在统计学差异。2例接受阿司匹林治疗的患者、1例接受华法林治疗的患者以及5例未接受抗凝或抗血小板治疗的患者发生了出血并发症。
抗血小板或抗凝治疗可能降低GCA患者的缺血事件风险。未观察到出血并发症风险增加。
