Vaskulárna medicína 3/2016

The risk of venous thromboembolism in giant cell arteritis

Introduction: Giant cell arteritis (GCA) is quite frequent form of vasculitis in adults characterized by systemic immune mediated granulomatous inflammation of the large and medium-sized arteries. Association with atherothrombotic events is well known, while risk of venous thromboembolism (VTE) is being underestimated. The aim of the present study was to determine risk factor profile, to evaluate the risk of VTE in patients with GCA and describe vascular treatment. Methods: A total of 27 GCA patients aged 71±9.7, 21 female and 6 male, without history of VTE were studied. GCA patients suffered from type 2 diabetes mellitus or impaired glucose tolerance in 77.7%, arterial hypertension in 92.6%, 14.8 % were active smokers. These were compared to 30 control patients without history of any cardiovascular event, being of similar age and sex. Results: Among 27 patients with GCA, 1 developed proximal deep vein thrombosis and 3 superficial vein thrombosis during 2 years of retrospective study. 21 patients were treated with low dose aspirin, 3 had sulodexid. Varicose veins were present in 29.6 % GCA patients and 33.3% non-GCA patients. All of the GCA patients were treated with low dose cortiscosteroids, 25.9 % had COX-2 inhibitors. In control group there was no VTE event. Conclusion: Patients with GCA have an increased risk of VTE, especially within short period after GCA diagnosis. The advanced age of these patients together with the concomitant cardiovascular risk factors, decreased mobility, trombocytosis and treatment with corticosteroids contribute to increased thrombotic risk. Treatment with low dose aspirin is already routine practice to prevent ischaemic events. The role of thromboprophylaxis is still debatable. It is evident that the optimal thromboprophylaxis needs more vigilance in GCA patients.

Keywords: giant cell arteritis, venous thromboembolism, thromboprofylaxis