Effect of antiplatelet/anticoagulant therapy on severe ischemic complications in patients with giant cell arteritis: a cumulative meta-analysis.

ABSTRACT

OBJECTIVE: To evaluate the effect of antiplatelet/anticoagulant therapy on the occurrence of severe ischemic complications in GCA patients at diagnosis and while on treatment with corticosteroids (CS), and the risk of bleeding in these patients. METHODS: A comprehensive search of PubMed and the Cochrane Central Register of Controlled Trials databases was completed and supplemented by hand searching of the references of all selected articles published from 1992 through December 2012. The cumulative meta-analysis included 6 retrospective studies that provided a total of 914 GCA patients. The effect of established antiplatelet/anticoagulant therapy on the occurrence of severe ischemic complications in patients with GCA at diagnosis and on the development of new severe ischemic complications in patients with GCA after diagnosis and while on treatment with CS were evaluated; as well as the risk of bleeding in patients with GCA on concomitant treatment with CS and antiplatelet/anticoagulant therapy. RESULTS: Antiplatelet/anticoagulant therapy before the diagnosis of GCA was not associated with a protection to develop severe ischemic complications (OR 0.661; 95% CI [0.287-1.520]; p=0.33). However, such a therapy may prevent from severe ischemic complications after the diagnosis of GCA (OR 0.318; [0.101-0.996]; p=0.049) without increasing the risk of bleeding in patients with GCA on concomitant treatment with CS (OR 0.658; [0.089-4.856]; p=0.682). CONCLUSIONS: Antiplatelet/anticoagulant therapy prior to the diagnosis of GCA was not associated with reduction in severe ischemic complications. However, antiplatelet/anticoagulant therapy demonstrated a marginal benefit when used together with CS therapy in patients with established GCA without associated bleeding risk.