Thromboembolic events in giant cell arteritis: a scoping review

Giant cell arteritis (GCA) is a granulomatous vasculitis that can cause severe ischemic complications. GCA also faces an increased risk of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (PE). Understanding the burden and predictors of VTE in GCA is crucial to improving patient care.

We conducted a scoping review using PubMed. We identified studies published since August 1990 that reported VTE in adults with GCA. Eligible designs included randomized trials, cohort studies, case-control studies, and case series with ≥5 patients. Data extraction included study characteristics, patient demographics, and VTE outcomes. Findings were synthesized qualitatively, given expected heterogeneity.

Out of 260 records screened, eight studies comprising 36 932 patients with GCA were included. Across studies, 1579 patients (4.3%) experienced VTE. Meta-analyses and large cohort studies consistently reported an elevated risk of VTE compared with controls, with odds ratios ranging from 1.9 to 4.1. The risk was greatest in the first year after diagnosis (relative risks up to 11), declining over time but remaining persistently elevated for at least 5 years. Associated characteristics included inpatient diagnosis, higher comorbidity burden, prior hospitalizations, thrombocytosis, and prior history of VTE, while traditional cardiovascular risk factors were not consistently associated. Mortality was higher in patients with GCA who developed VTE compared to those without.

This review confirms that GCA confers a substantially increased risk of VTE, particularly within the first year after diagnosis. Larger prospective studies are needed to refine prediction models and guide preventive strategies.