Background/Purpose: Giant cell arteritis (GCA) and Temporal arteritis (TA) is characterized by chronic granulomatous inflammation in medium and large-sized vessels.  It affects 20 in 100,000 people aged 50 and older in the United States. Temporal artery biopsy (TAB) is a common diagnostic tool. Patients are often on anticoagulation (AC) therapy for other comorbidities.  In current clinical practice, there are no guidelines on AC use perioperatively for TAB.  Our study aimed at examining whether AC therapy was held prior to TAB as well as potential complications post-biopsy in our hospital.  

Methods: The study is a retrospective chart review and was approved by the Stony Brook University Institutional Review Board. Electronic Medical Records (EMRs) were searched using ICD 9 and 10 codes for GCA among hospitalized patients between January 2013 and December 2016. Relevant data was collected, including demographics, AC usage and potential TAB related complications, such as ecchymosis, hematoma, infection, wound dehiscence, and facial nerve injury. TAB was performed by General or Vascular Surgeons in our hospital and documented by standard procedure in the EMRs. In most cases, ultrasound was used to map out temporal artery, lidocaine was administered locally, and a segment of temporal artery was obtained. Descriptive statistics and chi-square/fisher exact tests were used for the data analysis.

Results: Forty-six patients were included in this study due to high clinical suspicion for GCA. The mean age of the patients was 72.8 years, females accounted for 67.4% of patients, and 76.7% were Caucasian. Twenty-seven of 46 patients underwent TAB, of whom 20 patients were on AC therapy prior to procedure. All but one patient continued AC prior to TAB. Of the 20 patients with TAB, surgical data was available in 16 patients. Thirteen patients did not experience complications and only 3 patients reported incision site pain, minor bleeding, or small ecchymosis. There was no significant difference in TAB-associated complications between the two groups. Aspirin dosing was 81 mg, except one patient on 325 mg, and clopidogrel dosing was 75 mg daily. Perioperative use of AC medications and TAB-associated complications are shown in Table 1 and 2.

Conclusion: This study indicates that patients who continued AC prior to TAB developed minimal TAB-associated complications. Our data seems to support the view that there may be inadequate evidence to recommend holding anticoagulation prior to TAB. A prospective study of a large sample size is needed to confirm the results.