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M.S. Lee, S.D. Smith; Antiplatelet Therapy and Anticoagulation in Patients With Giant Cell Arteritis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):646.
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Purpose: Vision loss and cerebrovascular accidents often complicate giant cell arteritis. Antiplatelet therapy and anticoagulation reduce the risk of secondary stroke and of primary cardioembolic stroke but may increase the risk of bleeding complications. We sought to determine whether antiplatelet therapy or warfarin affects the ischemic complications or the risk of bleeding complications in patients with giant cell arteritis. Methods: From January 1989 to November 2004, a retrospective review of charts identified by the ICD–9 code for giant cell arteritis was conducted. For inclusion in this study, patients needed a positive temporal artery biopsy or significant clinical evidence to make a biopsy–negative diagnosis by an experienced rheumatologist. Information reviewed included demographic data, date of diagnosis, date of initial documentation of antiplatelet or warfarin use, date of vision loss or stroke, and presence of bleeding complications. Results: There were 133 patients, 32 men and 103 women with a mean age of 70.8 years. Over 95% of the patients were white. There were a total 78 patients on antiplatelet or anticoagulant therapy but 17 were begun after the ischemic complication. Fifty–five patients were not on antiplatelet or anticoagulant therapy. Nine of 61 (14.8%) patients suffered either a hemispheric stroke or vision loss while on aspirin, clopidogrel or coumadin compared to 34 of 72 (47.2%) patients not on antiplatelet or anticoagulant therapy (p<0.0005). Seven patients suffered a bleeding complication – five patients (11%) were on prednisone alone, two patients were on plavix or coumadin (3%) (p= 0.1). Conclusions: Antiplatelet or anticoagulant therapy may reduce the risk of vision loss or hemispheric stroke in patients with giant cell arteritis. An increased risk of bleeding complications with was not observed.
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