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Published on: February 8, 2019
Antiplatelet therapy to prevent ischemic events in giant cell arteritis: protocol for a systematic review and
Jean-Paul Makhzoum1, Youssef Baati2, Octavian Tanase2
1Vasculitis Clinic, Hopital Sacre-Coeur, University of Montreal, Canadian Vasculitis Research Network, 5400 Bd Gouin O, Montreal, QC, H4J1C5, Canada. jean-paul.makhzoum@umontreal.ca.
Insights
This systematic review evaluates antiplatelet therapy for preventing ischemic events in giant cell arteritis (GCA). Evidence is needed to balance the benefits of preventing blindness and stroke against bleeding risks.
Area of Science:
- Rheumatology
- Cardiology
- Neurology
Background:
- Giant cell arteritis (GCA) is a common vasculitis in adults.
- GCA can lead to severe ischemic events like blindness, stroke, and myocardial infarction.
- Conflicting data exists on the efficacy of antiplatelet therapy in GCA.
Purpose of the Study:
- To systematically review the safety and efficacy of oral antiplatelet therapy in preventing GCA-related ischemic events.
- To assess the risk of bleeding associated with antiplatelet use in GCA patients.
Main Methods:
- Systematic review including RCTs, cohort, and case-control studies.
- Intervention: oral antiplatelet agents (aspirin, clopidogrel, etc.) at GCA onset/relapse.
- Comparator: absence of antiplatelet therapy; outcomes assessed at 6 and 12 months.
Main Results:
- Primary outcome: GCA-related ischemic events (blindness, stroke, MI, related deaths).
- Secondary outcome: Adverse events, including major bleeding and bleeding-related deaths.
- Data synthesis will compare antiplatelet use versus no antiplatelet therapy.
Conclusions:
- GCA-related ischemic events are severe and irreversible.
- Antiplatelet agents are accessible and potentially effective for prevention.
- Balancing antiplatelet benefits against bleeding risks is crucial for clinical decision-making.
Background:
Giant cell arteritis (GCA) is the most common systemic vasculitis in adults. Presenting features include new-onset headaches, constitutional symptoms, jaw claudication, polymyalgia rheumatica, and visual symptoms. Arterial inflammation with subsequent stenosis and occlusion may cause tissue ischemia, leading to blindness, strokes, and myocardial infarction. Oral antiplatelet therapy has been hypothesized to reduce GCA-related ischemic events. However, previous studies have demonstrated conflicting results regarding the efficacy of antiplatelet agents in GCA. The objective of this systematic review is to assess the safety and efficacy of antiplatelet therapy for the prevention of these events in adults with giant cell arteritis.
Methods:
In this systematic review, we will include randomized controlled trials (RTCs), quasi-randomized trials, non-randomized intervention studies, cohort studies, and case-control studies on patients with new-onset or relapsing GCA. The intervention of interest will be pre-existing use or initiation of an oral antiplatelet medication (aspirin, clopidogrel, prasugrel, or ticagrelor) at GCA onset or relapse. The comparator of interest will be the absence of antiplatelet therapy. Endpoints will be evaluated after 6 and 12 months of follow-up. The primary outcome will be GCA-related ischemic events, including permanent blindness, stroke, myocardial infarction, and ischemic event-related deaths. Adverse events such as major bleeding and death caused by a bleeding event will be assessed.
Discussion:
GCA-related ischemic events are catastrophic, sudden, often irreversible, and lead to significant morbidity. Antiplatelet agents are affordable, accessible, and could be effective for the prevention of these events. Nevertheless, the potential benefits of platelet aggregation inhibition must be weighed against their associated risk of bleeding. Assessing the efficacy and safety of antiplatelet therapy in GCA is therefore clinically important.
Systematic Review Registration:
Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42023441574.
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