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Abstract：
BACKGROUND: Giant cell arteritis (GCA) is the most common systemic vasculitis in adults. Presenting features include new-onset headaches, constitutional symptoms, jaw claudication, polymyalgia rheumatica, and visual symptoms. Arterial inflammation with subsequent stenosis and occlusion may cause tissue ischemia, leading to blindness, strokes, and myocardial infarction. Oral antiplatelet therapy has been hypothesized to reduce GCA-related ischemic events. However, previous studies have demonstrated conflicting results regarding the efficacy of antiplatelet agents in GCA. The objective of this systematic review is to assess the safety and efficacy of antiplatelet therapy for the prevention of these events in adults with giant cell arteritis.
METHODS: In this systematic review, we will include randomized controlled trials (RTCs), quasi-randomized trials, non-randomized intervention studies, cohort studies, and case-control studies on patients with new-onset or relapsing GCA. The intervention of interest will be pre-existing use or initiation of an oral antiplatelet medication (aspirin, clopidogrel, prasugrel, or ticagrelor) at GCA onset or relapse. The comparator of interest will be the absence of antiplatelet therapy. Endpoints will be evaluated after 6 and 12 months of follow-up. The primary outcome will be GCA-related ischemic events, including permanent blindness, stroke, myocardial infarction, and ischemic event-related deaths. Adverse events such as major bleeding and death caused by a bleeding event will be assessed.
CONCLUSIONS: GCA-related ischemic events are catastrophic, sudden, often irreversible, and lead to significant morbidity. Antiplatelet agents are affordable, accessible, and could be effective for the prevention of these events. Nevertheless, the potential benefits of platelet aggregation inhibition must be weighed against their associated risk of bleeding. Assessing the efficacy and safety of antiplatelet therapy in GCA is therefore clinically important.
BACKGROUND: Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42023441574.
METHODS: In this systematic review, we will include randomized controlled trials (RTCs), quasi-randomized trials, non-randomized intervention studies, cohort studies, and case-control studies on patients with new-onset or relapsing GCA. The intervention of interest will be pre-existing use or initiation of an oral antiplatelet medication (aspirin, clopidogrel, prasugrel, or ticagrelor) at GCA onset or relapse. The comparator of interest will be the absence of antiplatelet therapy. Endpoints will be evaluated after 6 and 12 months of follow-up. The primary outcome will be GCA-related ischemic events, including permanent blindness, stroke, myocardial infarction, and ischemic event-related deaths. Adverse events such as major bleeding and death caused by a bleeding event will be assessed.
CONCLUSIONS: GCA-related ischemic events are catastrophic, sudden, often irreversible, and lead to significant morbidity. Antiplatelet agents are affordable, accessible, and could be effective for the prevention of these events. Nevertheless, the potential benefits of platelet aggregation inhibition must be weighed against their associated risk of bleeding. Assessing the efficacy and safety of antiplatelet therapy in GCA is therefore clinically important.
BACKGROUND: Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42023441574.
摘要：
背景：巨细胞动脉炎（GCA）是成人最常见的系统性血管炎。呈现的特征包括新发头痛，宪法症状，颌骨跛行,风湿性多肌痛，视觉症状。动脉炎症与随后的狭窄和闭塞可能导致组织缺血。导致失明,笔画,和心肌梗塞。据推测，口服抗血小板治疗可减少GCA相关的缺血事件。然而,以往的研究表明,关于抗血小板药物在GCA中的疗效,结果相互矛盾.本系统评价的目的是评估抗血小板治疗在成人巨细胞动脉炎中预防这些事件的安全性和有效性。
方法：在这篇系统综述中，我们将包括随机对照试验(RTC)，准随机试验，非随机干预研究，队列研究，以及新发或复发GCA患者的病例对照研究。感兴趣的干预将是预先存在的使用或开始口服抗血小板药物(阿司匹林，氯吡格雷,普拉格雷,或替格瑞洛）在GCA发作或复发时。感兴趣的比较将是缺乏抗血小板治疗。终点将在随访6个月和12个月后进行评估。主要结局将是GCA相关的缺血事件，包括永久性失明,中风,心肌梗塞,和缺血性事件相关死亡。将评估不良事件，例如大出血和由出血事件引起的死亡。
结论：与GCA相关的缺血事件是灾难性的，突然,往往是不可逆转的,并导致显著的发病率。抗血小板药物是负担得起的，可访问,可以有效预防这些事件。然而，血小板聚集抑制的潜在益处必须与相关的出血风险进行权衡.因此，评估抗血小板治疗在GCA中的有效性和安全性在临床上很重要。
背景：我们的系统审查方案已在国际系统审查前瞻性登记册（PROSPERO，注册号CRD42023441574。
方法：在这篇系统综述中，我们将包括随机对照试验(RTC)，准随机试验，非随机干预研究，队列研究，以及新发或复发GCA患者的病例对照研究。感兴趣的干预将是预先存在的使用或开始口服抗血小板药物(阿司匹林，氯吡格雷,普拉格雷,或替格瑞洛）在GCA发作或复发时。感兴趣的比较将是缺乏抗血小板治疗。终点将在随访6个月和12个月后进行评估。主要结局将是GCA相关的缺血事件，包括永久性失明,中风,心肌梗塞,和缺血性事件相关死亡。将评估不良事件，例如大出血和由出血事件引起的死亡。
结论：与GCA相关的缺血事件是灾难性的，突然,往往是不可逆转的,并导致显著的发病率。抗血小板药物是负担得起的，可访问,可以有效预防这些事件。然而，血小板聚集抑制的潜在益处必须与相关的出血风险进行权衡.因此，评估抗血小板治疗在GCA中的有效性和安全性在临床上很重要。
背景：我们的系统审查方案已在国际系统审查前瞻性登记册（PROSPERO，注册号CRD42023441574。
