Share This Article:

The Use of Anti-Platelet and/or Anticoagulant Agents in the Prevention of Large Vessel Vasculitis-Associated Ischemic Complications: A Meta-Analysis

Abstract Full-Text HTML XML Download Download as PDF (Size:1249KB) PP. 114-123
DOI: 10.4236/ojra.2014.42017    2,856 Downloads   4,288 Views   Citations

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.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Jeong, J. and Barra, L. (2014) The Use of Anti-Platelet and/or Anticoagulant Agents in the Prevention of Large Vessel Vasculitis-Associated Ischemic Complications: A Meta-Analysis. Open Journal of Rheumatology and Autoimmune Diseases, 4, 114-123. doi: 10.4236/ojra.2014.42017.

References

[1] Gonzalez-Gay, M.A., Vazquez-Rodriguez, T.R., Lopez-Diaz, M.J., Miranda-Filloy, J.A., Gonzalez-Juanatey, C., Martin, J., et al. (2009) Epidemiology of Giant Cell Arteritis and Polymyalgia Rheumatica. Arthritis & Rheumatology, 61, 1454-1461. http://dx.doi.org/10.1002/art.24459
[2] Johnston, S.L., Lock, R.J. and Gompels, M.M. (2002) Takayasu Arteritis: A Review. Journal of Clinical Pathology, 55, 481-486. http://dx.doi.org/10.1136/jcp.55.7.481
[3] Hunder, G.G. (2002) Epidemiology of Giant-Cell Arteritis. Cleveland Clinic Journal of Medicine, 69, SII79-SII82. http://dx.doi.org/10.3949/ccjm.69.Suppl_2.SII79
[4] Weyand, C.M. and Goronzy, J.J. (2003) Medium-and Large-Vessel Vasculitis. The New England Journal of Medicine, 349, 160-169. http://dx.doi.org/10.1056/NEJMra022694
[5] Salvarani, C., Cantini, F., Boiardi, L. and Hunder, G.G. (2002) Polymyalgia Rheumatica and Giant-Cell Arteritis. The New England Journal of Medicine, 347, 261-271. http://dx.doi.org/10.1056/NEJMra011913
[6] Hayreh, S.S., Podhajsky, P.A. and Zimmerman, B. (1998) Ocular Manifestations of Giant Cell Arteritis. American Journal of Ophthalmology, 125, 509-520. http://dx.doi.org/10.1016/S0002-9394(99)80192-5
[7] Caselli, R.J., Hunder, G.G. and Whisnant, J.P. (1988) Neurologic Disease in Biopsy-Proven Giant Cell (Temporal) Arteritis. Neurology, 38, 352-359. http://dx.doi.org/10.1212/WNL.38.3.352
[8] Font, C., Cid, M.C., Coll-Vinent, B., Lopez-Soto, A. and Grau, J.M. (1997) Clinical Features in Patients with Permanent Visual Loss Due to Biopsy-Proven Giant Cell Arteritis. British Journal of Rheumatology, 36, 251-254. http://dx.doi.org/10.1093/rheumatology/36.2.251
[9] Gonzalez-Gay, M.A., Alonso, M.D., Aguero, J.J., Bal, M., Fernandez-Camblor, B. and Sanchez-Andrade, A. (1992) Temporal Arteritis in a Northwestern Area of Spain: Study of 57 Biopsy Proven Patients. British Journal of Rheumatology, 19, 277-280.
[10] Gonzalez-Gay, M.A., Blanco, R., Rodriguez-Valverde, V., Martinez-Taboada, V.M., Delgado-Rodriguez, M., Figueroa, M., et al. (1998) Permanent Visual Loss and Cerebrovascular Accidents in Giant Cell Arteritis: Predictors and Response to Treatment. Arthritis & Rheumatology, 41, 1497-1504. http://dx.doi.org/10.1002/1529-0131(199808)41:8<1497::AID-ART22>3.0.CO;2-Z
[11] Perruquet, J.L., Davis, D.E. and Harrington, T.M. (1986) Aortic Arch Arteritis in the Elderly. An Important Manifestation of Giant Cell Arteritis. Archives of Internal Medicine, 146, 289-291. http://dx.doi.org/10.1001/archinte.1986.00360140107015
[12] Ninet, J.P., Bachet, P., Dumontet, C.M., Du Colombier, P.B., Stewart, M.D. and Pasquier, J.H. (1990) Subclavian and Axillary Involvement in Temporal Arteritis and Polymyalgia Rheumatica. American Journal of Medicine, 88, 13-20. http://dx.doi.org/10.1016/0002-9343(90)90121-S
[13] Klein, R.G., Hunder, G.G., Stanson, A.W. and Sheps, S.G. (1975) Large Artery Involvement in Giant Cell (Temporal) Arteritis. Annals of Internal Medicine, 83, 806-812. http://dx.doi.org/10.7326/0003-4819-83-6-806
[14] Mwipatayi, B.P., Jeffery, P.C., Beningfield, S.J., Matley, P.J., Naidoo, N.G., Kalla, A.A., et al. (2005) Takayasu Arteritis: Clinical Features and Management: Report of 272 Cases. ANZ Journal of Surgery, 75, 110-117. http://dx.doi.org/10.1111/j.1445-2197.2005.03312.x
[15] Kerr, G.S., Hallahan, C.W., Giordano, J., Leavitt, R.Y., Fauci, A.S., Rottem, M., et al. (1994) Takayasu Arteritis. Annals of Internal Medicine, 120, 919-929. http://dx.doi.org/10.7326/0003-4819-120-11-199406010-00004
[16] Park, M.C., Lee, S.W., Park, Y.B., Chung, N.S. and Lee, S.K. (2005) Clinical Characteristics and Outcomes of Takayasu’s Arteritis: Analysis of 108 Patients Using Standardized Criteria for Diagnosis, Activity Assessment, and Angiographic Classification. Scandinavian Journal of Rheumatology, 34, 284-292. http://dx.doi.org/10.1080/03009740510026526
[17] Isobe, M. (2013) Takayasu Arteritis Revisited: Current Diagnosis and Treatment. International Journal of Cardiology, 168, 3-10. http://dx.doi.org/10.1016/j.ijcard.2013.01.022
[18] Borg, F.A. and Dasgupta, B. (2009) Treatment and Outcomes of Large Vessel Arteritis. Best Practice and Research Clinical Rheumatology, 23, 325-337.
[19] Antithrombotic Trialists’ (ATT) Collaboration, Baigent, C., Blackwell, L., Collins, R., Emberson, J., Godwin, J., et al. (2009) Aspirin in the Primary and Secondary Prevention of Vascular Disease: Collaborative Meta-Analysis of Individual Participant Data from Randomised Trials. Lancet, 373, 1849-1860. http://dx.doi.org/10.1016/S0140-6736(09)60503-1
[20] Mukhtyar, C., Guillevin, L., Cid, M.C., Dasgupta, B., de Groot, K., Gross, W., et al. (2009) EULAR Recommendations for the Management of Large Vessel Vasculitis. Annals of the Rheumatic Diseases, 68, 318-323. http://dx.doi.org/10.1136/ard.2008.088351
[21] The Newcastle-Ottawa Scale (NOS) for Assessing the Quality if Nonrandomized Studies in Meta-Analyses. 2011. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm
[22] Vandenbroucke, J.P., von Elm, E., Altman, D.G., Gotzsche, P.C., Mulrow, C.D., Pocock, S.J., et al. (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. Annals of Internal Medicine, 147, W163-W194. http://dx.doi.org/10.7326/0003-4819-147-8-200710160-00010-w1
[23] de Souza, A.W., Machado, N.P., Pereira, V.M., Arraes, A.E., Reis Neto, E.T., Mariz, H.A. and Sato, E.I. (2010) Antiplatelet Therapy for the Prevention of Arterial Ischemic Events in Takayasu Arteritis. Circulation Journal: Official Journal of the Japanese Circulation Society, 74, 1236-1241.
[24] Berger, C.T., Wolbers, M., Meyer, P., Daikeler, T. and Hess, C. (2009) High Incidence of Severe Ischaemic Complications in Patients with Giant Cell Arteritis Irrespective of Platelet Count and Size, and Platelet Inhibition. Rheumatology (Oxford), 48, 258-261.
http://dx.doi.org/10.1093/rheumatology/ken480
[25] Salvarani, C., Della Bella, C., Cimino, L., Macchioni, P., Formisano, D., Bajocchi, G., Pipitone, N., Catanoso, M.G., Restuccia, G., Ghinoi, A. and Boiardi, L. (2009) Risk Factors for Severe Cranial Ischaemic Events in an Italian Population-Based Cohort of Patients with Giant Cell Arteritis. Rheumatology, 48, 250-253.
[26] Narváez, J., Bernad, B., Gómez-Vaquero, C., García-Gómez, C., Roig-Vilaseca, D., Juanola, X., Rodriguez-Moreno, J., Nolla, J.M. and Valverde, J. (2008) Impact of Antiplatelet Therapy in the Development of Severe Ischemic Complications and in the Outcome of Patients with Giant Cell Arteritis. Clinical and Experimental Rheumatology, 26, S57-S62.
[27] Lee, M.S., Smith, S.D., Galor, A. and Hoffman, G.S. (2006) Antiplatelet and Anticoagulant Therapy in Patients with Giant Cell Arteritis. Arthritis and Rheumatism, 54, 3306-3309.
[28] Nesher, G., Berkun, Y., Mates, M., Baras, M., Rubinow, A. and Sonnenblick, M. (2004) Low-Dose Aspirin and Prevention of Cranial Ischemic Complications in Giant Cell Arteritis. Arthritis and Rheumatism, 50, 1332-1337.
[29] Gonzalez-Gay, M.A., Pineiro, A., Gomez-Gigirey, A., Garcia-Porrua, C., Pego-Reigosa, R., Dierssen-Sotos, T. and Llorca, J. (2004) Influence of Traditional Risk Factors of Atherosclerosis in the Development of Severe Ischemic Complications in Giant Cell Arteritis. Medicine (Baltimore), 83, 342-347. http://dx.doi.org/10.1097/01.md.0000145369.25558.b5
[30] Dai, Y. and Ge, J. (2012) Clinical Use of Aspirin in Treatment and Prevention of Cardiovascular Disease. Thrombosis, 2012, Article ID: 245037.
[31] Numano, F., Shimokado, K., Kishi, Y., Nishiyama, K., Turkoglu, C., Yajima, M., Numano, F. and Maezawa, H. (1982) Changes in the Plasma Levels of Thromboxane B2 and Cyclic Nucleotides in Patients with Takayasu Disease. Japanese Circulation Journal, 46, 16-20.
http://dx.doi.org/10.1253/jcj.46.16
[32] Numano, F., Maruyama, Y., Koyama, T. and Numano, F. (1986) Antiaggregative Aspirin Dosage at the Affected Vessel Wall. Angiology, 37, 695-701. http://dx.doi.org/10.1177/000331978603701001
[33] Kasuya, N., Kishi, Y., Isobe, M., Yoshida, M. and Numano, F. (2006) P-Selectin Expression, but Not GPIIb/IIIa Activation, Is Enhanced in the Inflammatory Stage of Takayasu’s Arteritis. Circulation Journal, 70, 600-604. http://dx.doi.org/10.1253/circj.70.600
[34] Borchers, A.T. and Gershwin, M.E. (2012) Giant Cell Arteritis: A Review of Classification, Pathophysiology, Geoepidemiology and Treatment. Autoimmunity Reviews, 11, A544-A554.
[35] Ly, K.H., Regent, A., Tamby, M.C. and Mouthon, L. (2010) Pathogenesis of Giant Cell Arteritis: More than Just an Inflammatory Condition? Autoimmunity Reviews, 9, 635-645.
http://dx.doi.org/10.1016/j.autrev.2010.05.002
[36] Weyand, C.M. and Goronzy, J.J. (2003) Giant-Cell Arteritis and Polymyalgia Rheumatica. Annals of Internal Medicine, 139, 505-515.
[37] Chiang, N., Bermudez, E.A., Ridker, P.M., Hurwitz, S. and Serhan, C.N. (2004) Aspirin Triggers Antiinflammatory 15-epi-lipoxin A4 and Inhibits Thromboxane in a Randomized Human Trial. Proceedings of the National Academy of Sciences of the United States of America, 101, 15178-15183.
http://dx.doi.org/10.1073/pnas.0405445101
[38] Santilli, F., Davi, G., Consoli, A., Cipollone, F., Mezzetti, A., Falco, A., Taraborelli, T., Devangelio, E., Ciabattoni, G., Basili, S. and Patrono, C. (2006) Thromboxane-Dependent CD40 ligand Release in Type 2 Diabetes Mellitus. Journal of the American College of Cardiology, 47, 391-397.
http://dx.doi.org/10.1016/j.jacc.2005.03.079
[39] Weyand, C.M., Kaiser, M., Yang, H., Younge, B. and Goronzy, J.J. (2002) Therapeutic Effects of Acetylsalicylic Acid in Giant Cell Arteritis. Arthritis & Rheumatism, 46, 457-466.
http://dx.doi.org/10.1002/art.10071
[40] Cohen Tervaert, J.W. (2013) Cardiovascular Disease Due to Accelerated Atherosclerosis in Systemic Vasculitides. Best Practice & Research Clinical Rheumatology, 27, 33-44.
http://dx.doi.org/10.1016/j.berh.2012.12.004

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.