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Antiplatelet therapy and its role on reducing ischemic events in patients with giant-cell arteritis : a systematic review and meta-analysis
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Introdução: A Arterite de Células Gigantes (ACG) é uma vasculite de grandes vasos que ocorre em pacientes com mais de 50 anos e que resulta de uma inflamação crónica na parede dos vasos. Pode ter complicações significativas, como perda de visão ou acidentes cerebrovasculares. Esta doença deve ser imediatamente tratada com corticoterapia em alta dose. A aspirina pode ser opção, se utilizada como adjuvante, pois pode reduzir/prevenir estes eventos isquémicos.
Objetivo: O nosso objetivo é avaliar a eficácia dos antiagregantes na redução de eventos iquémicos, em pacientes com ACG e, em simultâneo, avaliar a sua segurança e efeito na sobrevida.
Métodos: Até abril de 2022, foi efetuada uma pesquisa nas seguintes plataformas: MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) e EMBASE. Não foram consideradas restrições de idioma ou data de publicação. A seleção dos estudos foi realizada, independentemente, com recurso aos critérios de inclusão e exclusão, e os respetivos dados inseridos numa tabela previamente definida. O risco de viés foi avaliado, individualmente, através da Newcastle-Ottawa Scale (NOS Scale) e procedeu-se à análise estatística.
Resultados: Esta meta-análise mostrou um OR 0.45 (95%CI: 0.15-1.35) para o efeito do antiagregantes na redução dos eventos isquémicos, quando ajustado para fatores confundidores e um OR 1.19 (95%CI 0.49-2.93), quando não ajustado. A heterogeneidade foi significativa e moderada, respetivamente. Um estudo recente, que avaliou o efeito dos antiagregantes na sobrevida, mostrou um OR 0.62 (95%CI 0.44-0.89). A análise do risco hemorrágico mostrou um OR 0.28 (95%CI 0.08-1.01).
Conclusão: Não foi encontrada evidência que defenda que os antiagregantes possam reduzir os eventos isquémicos, nos doentes com ACG. Contudo, verificou-se que pode ter um efeito benéfico na sobrevida e que não parece aumentar o risco hemorrágico destes doentes.
Background: Giant Cell Arteritis (GCA) is large-vessel vasculitis that occurs in individuals above 50 years of age. It results from chronic inflammation within the vessel wall, leading to ischemia. Significant complications may arise, such as irreversible vision loss and cerebrovascular accidents (CVA). Distal arterial branches can also be affected. GCA should be promptly treated, using a high dose of glucocorticoids. Aspirin may be a therapeutic option if used as an adjuvant. It may have a role in reducing or preventing these ischemic events. Objective: Considering the existing uncertainty about the use of aspirin in GCA, we aim to assess the efficacy of antiplatelet therapy in reducing ischemic events, in patients with GCA and also assess its safety and effect in survival. Methods: We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. The search was conducted until April 2022, with no restrictions regarding publication date or language. Study selection was made by the two reviewers, independently. Titles and abstracts were screened using the inclusion and exclusion criteria. Data from the included studies was extracted onto a pre-piloted data sheet. Risk of bias was evaluated for each study using the Newcastle-Ottawa Scale (NOS Scale). Statistical analysis was then conducted. Results: Our meta-analysis showed an OR 0.45 (95%CI: 0.15-1.35) for antiplatelets’ effect in reducing ischemic events, when adjusted for confounding factors and an OR 1.19 (95%CI 0.49-2.93), when not adjusted. Heterogeneity was significant and moderate, respectively. A new study showed an OR 0.62 (95%CI 0.44-0.89) for antiplatelets’ effect in survival. Bleeding risk analysis showed an OR 0.28 (95%CI 0.08-1.01). Conclusion: Our review found no evidence that antiplatelets may reduce ischemic events in patients with GCA. However, we found that it may have a beneficial effect on survival and it does not seem to increase the bleeding risk in these patients.
Background: Giant Cell Arteritis (GCA) is large-vessel vasculitis that occurs in individuals above 50 years of age. It results from chronic inflammation within the vessel wall, leading to ischemia. Significant complications may arise, such as irreversible vision loss and cerebrovascular accidents (CVA). Distal arterial branches can also be affected. GCA should be promptly treated, using a high dose of glucocorticoids. Aspirin may be a therapeutic option if used as an adjuvant. It may have a role in reducing or preventing these ischemic events. Objective: Considering the existing uncertainty about the use of aspirin in GCA, we aim to assess the efficacy of antiplatelet therapy in reducing ischemic events, in patients with GCA and also assess its safety and effect in survival. Methods: We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. The search was conducted until April 2022, with no restrictions regarding publication date or language. Study selection was made by the two reviewers, independently. Titles and abstracts were screened using the inclusion and exclusion criteria. Data from the included studies was extracted onto a pre-piloted data sheet. Risk of bias was evaluated for each study using the Newcastle-Ottawa Scale (NOS Scale). Statistical analysis was then conducted. Results: Our meta-analysis showed an OR 0.45 (95%CI: 0.15-1.35) for antiplatelets’ effect in reducing ischemic events, when adjusted for confounding factors and an OR 1.19 (95%CI 0.49-2.93), when not adjusted. Heterogeneity was significant and moderate, respectively. A new study showed an OR 0.62 (95%CI 0.44-0.89) for antiplatelets’ effect in survival. Bleeding risk analysis showed an OR 0.28 (95%CI 0.08-1.01). Conclusion: Our review found no evidence that antiplatelets may reduce ischemic events in patients with GCA. However, we found that it may have a beneficial effect on survival and it does not seem to increase the bleeding risk in these patients.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Arterite de células gigantes Isquémia Vasculite Revisão sistemática Antiagregantes Neurologia