Background/Purpose:

Large Vessel Vasculitides (LVV) consist of Giant Cell Arteritis and Takayasu’s Arteritis, which are chronic systemic autoimmune diseases characterized by inflammation of large blood vessels leading to ischemic complications.  The objective of this study is to determine the effectiveness of antiplatelet agents at reducing ischemic events in patients with LVV.

Methods:

We performed a random effects meta-analysis examining antiplatelet (AP) and/or anticoagulant therapy (AC) and ischemic events in large vessel vasculitis (LVV).  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.  The primary study outcome was the risk of severe ischemic events in patients treated with AP/AC versus no treatment expressed as an odds ratio (OR).  The risk of any ischemic event was a secondary outcome.  When accounting for baseline atherosclerotic risk factors, AP/AC was protective for severe ischemic events: OR 0.20 (95% CI 0.12-0.32); as well as for any ischemic events: OR 0.33 (95% CI 0.13-0.81). Subgroup analyses established a prioriwere also performed comparing i) AP and AC therapy alone ii) ischemic events reported at baseline and follow-up.  AP alone had a protective effect on ischemic events when compared to no treatment when controlling for cardiovascular risk factors (OR 0.21, 95% CI 0.09-0.50).  AC did not appear to decrease ischemic events; however, there were only 2 studies that reported on AC separately from AP. On follow-up, a protective effect for AP/AC therapy was observed (OR 0.18 (95% CI 0.04-0.83)).

Conclusion:

Antiplatelet therapy significantly decreases ischemic events in patients with LVV. However, in most cases, the treatment was initiated prior to the diagnosis of vasculitis. Available studies do not address whether initiating antiplatelet therapy at the time of LVV diagnosis is beneficial.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/antiplatelet-agents-decrease-ischemic-complications-in-systemic-large-vessel-vasculitides-a-meta-analysis/