warfarin and Giant-Cell-Arteritis

Vision loss and cerebrovascular accidents often complicate giant cell arteritis (GCA). Antiplatelet and anticoagulant therapy reduce the risk of stroke in other populations. We sought to determine whether antiplatelet or anticoagulant therapy reduces ischemic complications in patients with GCA.. A retrospective chart review for patients with GCA was conducted. Included patients fulfilled modified 1990 American College of Rheumatology criteria for GCA. Collected information included demographic data, dates of antiplatelet or anticoagulant use, vision loss or stroke, and presence of bleeding complications and cerebrovascular risk factors.. A total of 143 patients were included with a mean followup period of 4 years. The cohort included 109 women (76%) and 34 men (24%) with a mean age of 71.8 years. A total of 104 patients (73%) had a biopsy-proven diagnosis. Eighty-six patients (60.1%) had received long-term antiplatelet or anticoagulant therapy, including 18 (12.6%) who did not start therapy until after an ischemic event had occurred. Antiplatelet agents or anticoagulants were not used in 57 patients (39.9%). Overall, 11 of 68 patients (16.2%) had an ischemic event while receiving antiplatelet or anticoagulant therapy, compared with 36 of 75 patients (48.0%) not receiving such therapy (P < 0.0005). Univariate analysis failed to show a statistical difference between groups in regard to cerebrovascular risk factors, age, sex, or biopsy-proven diagnosis. Bleeding complications occurred in 2 patients receiving aspirin, 1 patient receiving warfarin, and 5 patients who did not receive anticoagulant or antiplatelet therapy.. Antiplatelet or anticoagulant therapy may reduce the risk of ischemic events in patients with GCA. An increased risk of bleeding complications was not observed.

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; Brain Ischemia; Clopidogrel; Cohort Studies; Dose-Response Relationship, Drug; Female; Giant Cell Arteritis; Hemorrhage; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Retrospective Studies; Risk Factors; Stroke; Ticlopidine; Warfarin

Topics: Adrenal Cortex Hormones; Adult; Anemia, Hemolytic, Autoimmune; Biopsy, Needle; Diagnosis, Differential; Follow-Up Studies; Giant Cell Arteritis; Glomerulosclerosis, Focal Segmental; Headache; Humans; Intracranial Hypertension; Male; Migraine Disorders; Sleep Apnea Syndromes; Vision Disorders; Warfarin

A 76-year-old woman with giant cell (temporal) arteritis was described; she presented with a one year history of headache and tinnitus. Histopathological findings from a superficial temporal artery showed arteritis with granulomatous changes. Bilateral carotid arteriograms demonstrated the stenoses of both internal carotid arteries as well as the narrowing of the superficial temporal arteries. Although we dermatologists rarely encounter the disease in daily clinical practice, it is of clinical importance to perform cerebral angiography in patients suspected of temporal arteritis.

Topics: Aged; Anti-Inflammatory Agents; Anticoagulants; Carotid Arteries; Cerebral Angiography; Female; Giant Cell Arteritis; Humans; Hydroxyethyl Starch Derivatives; Plasma Substitutes; Platelet Aggregation Inhibitors; Prednisolone; Ticlopidine; Warfarin