Low‐dose aspirin and prevention of cranial ischemic complications in giant cell arteritis

Objective Cranial ischemic complications such as cerebrovascular accidents (CVAs) and acute visual loss are among the leading causes of giant cell arteritis (GCA)–related morbidity. In this retrospective study, we evaluated the effect of treatment with low‐dose aspirin on the incidence of cranial ischemic complications in GCA. Methods Charts of 175 consecutive patients in whom GCA was diagnosed between 1980 and 2000 were reviewed for medical data. Data for 166 patients who were followed up for at least 3 months were also available. Results At the time of the diagnosis of GCA, 36 patients (21%) had already been receiving low‐dose aspirin (100 mg/day). In all cases, the indication for this treatment was ischemic heart disease. There were no significant differences between the aspirin‐treated and non–aspirin‐treated groups regarding the mean age of patients, the male‐to‐female ratio, duration of GCA‐related symptoms, rates of headaches, systemic symptoms, and jaw claudication, and the mean erythrocyte sedimentation rate, hemoglobin count, and platelet count. Cerebrovascular risk factors (hypertension, hyperlipidemia, or diabetes mellitus) were more common in the aspirin‐treated group (38.9% versus 20%; P= 0.03). Cranial ischemic complications were diagnosed in 43 patients at presentation: 30 patients had acute visual loss, 11 had CVAs, and 2 had both conditions simultaneously. Only 3 of the aspirin‐treated patients (8%) presented with cranial ischemic complications, compared with 40 (29%) of the non–aspirin‐treated patients (P = 0.01). Despite the use of steroid therapy, cranial ischemic complications developed in 14 of the 166 patients followed up for 3 months or longer. However, cranial ischemic complications developed in only 3% of the aspirin‐treated patients, compared with 13% of the patients treated with prednisone only (P = 0.02). Conclusion These data suggest that low‐dose aspirin decreases the rate of visual loss and CVAs in patients with GCA.