Anticoagulant therapy reduces risks for vision loss, stroke in giant cell arteritis
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Key takeaways:
- Anticoagulant therapy before GCA diagnosis had a protective effect against cranial ischemic complications.
- Risk factors for complications included being aged older than 80 years and hypertension.
Patients with giant cell arteritis who use anticoagulants demonstrate lower risks for vision loss, stroke and other cranial ischemic complications, according to data published in Annals of the Rheumatic Diseases.
Meanwhile, older age and hypertension appeared to increase the risk for these complications in patients with GCA, the researchers wrote.
“Patients with GCA may present systemic symptoms, such as fever, malaise and weight loss; cranial symptoms, such as headache, scalp tenderness, jaw or tongue claudication, with or without cranial ischemic complications, such as vision loss or stroke,” Natalie J.M. Chaddock, PhD, of the Leeds Institute for Data Analytics at the University of Leeds, in the United Kingdom, and colleagues wrote.
“A history of ischemic manifestations at GCA diagnosis is linked with risk of subsequent visual loss,” they added. “We reasoned that identification of risk factors for ischemic manifestations at GCA presentation might identify a subset of patients who may benefit from more intensive monitoring and potentially adjunctive treatments.”
To assess the links between cardiovascular profiles and cranial ischemic complications in patients with GCA, Chaddock and colleagues analyzed data from 1,946 patients with GCA (median age, 71 years) included in the UKGCA Consortium and U.K. Biobank. The primary outcome was presentation of GCA with either ocular or non-ocular cranial ischemic complications.
After a process of variable selection using univariable and elastic net regression, the researchers used multivariable logistic regression to assess associations between sociodemographic, clinical variables and cranial ischemic complications.
Overall, 17% of the patients presented with cranial ischemic complications. According to multivariable analysis, the greatest risk factor was being aged older than 80 years, vs. aged younger than 60 years (adjusted OR = 1.6; 95% CI, 0.73-3.66). Meanwhile, using anticoagulant therapy before GCA diagnosis was associated with the greatest protective effect against cranial ischemic complications (adjusted OR = 0.21; 95% CI, 0.05-0.62).
Cranial ischemic complications were also associated with hypertension (adjusted OR = 1.35; 95% CI, 1.03-1.75) in a sensitivity analysis that did not include anticoagulation therapy, according to the researchers.
“This work identified risk factors associated with cranial ischaemic complications in GCA, which included age at diagnosis, hypertension and a potentially protective role of anticoagulant therapy in severe complications in GCA,” Chaddock and colleagues wrote. “It must be emphasized that, since unmeasured confounding could not be ruled out, these findings are not sufficient yet to change clinical practice. Positional gene mapping of an associated TIA PRS also highlighted genetic loci related to immune and coagulation pathways.
“Together, these results suggest a need for further interrogation of the role of thrombosis in GCA, and to elucidate whether anticoagulant therapy alongside glucocorticoids might be beneficial in patients with GCA, especially those with transient or monocular visual involvement, or other high-risk subsets,” they added.
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