Comment on: Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis.

摘要

Sir, Salvarani et al. [1] recently published an article on risk factors for severe cranial ischaemic events (CIEs) in GCA. Some words of caution are warranted regarding the results of the study and their interpretation.First, 33/38 included patients (87%) with CIE had visual loss, mostly due to anterior ischaemic optic neuritis. These patients largely outweigh those with cerebrovascular accidents and whether the results apply to the latter is unknown. Hence, this work should be viewed as a study on risk factors for visual loss, rather than CIE, in GCA.Secondly, it is especially worrying to read a claim of causation in the second key message, stating that 'anti-platelet or anti-coagulation therapy did not reduce the risk of cranial ischaemic events in GCA'. The positive association between anti-thrombotic therapy and CIE probably reveals the unsurprising fact that antecedent diseases treated with anti-thrombotic agents are associated with an increased risk of thrombotic events.