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Pharmacological secondary prevention in patients with mesenterial artery atherosclerosis and arterial embolism
1Department of Vascular Diseases, Skåne University Hospital, 2-205 02 Malmö, Sweden.
Insights
Secondary prevention is crucial for patients with visceral artery atherosclerosis. Management includes antiplatelet or anticoagulant therapy, blood pressure control, cholesterol reduction, diabetes management, and smoking cessation to prevent future ischemic events.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Cardiology
Background:
- Atherosclerotic occlusive lesions in visceral arteries (coeliac, SMA, IMA) can cause gastrointestinal ischemia.
- These lesions may involve thrombosis or embolization, leading to acute ischemic symptoms.
Purpose of the Study:
- To outline secondary prevention strategies for patients following treatment of acute visceral artery ischemic events.
- To provide guidance on pharmacological and non-pharmacological interventions to reduce recurrence risk.
Main Methods:
- Review of current guidelines and evidence for managing atherosclerotic mesenteric ischemia.
- Recommendations for antiplatelet, anticoagulant, antihypertensive, and lipid-lowering therapies.
- Emphasis on risk factor modification including diabetes control and smoking cessation.
Main Results:
- Patients require tailored antiplatelet (aspirin, clopidogrel) or anticoagulant (warfarin, DOACs) therapy based on etiology.
- Strict blood pressure (<140/90 mmHg) and LDL-cholesterol (<1.8 mmol/l) targets are recommended.
- Management of diabetes and smoking cessation are vital components of secondary prevention.
Conclusions:
- Comprehensive secondary prevention is essential for patients with visceral artery atherosclerosis to prevent recurrent ischemic manifestations.
- A multi-faceted approach combining medical management and lifestyle modifications improves outcomes.
Abstract:
Visceral arteries such as the coeliac (CA), superior mesenteric (SMA), and the inferior mesenteric artery (IMA) might be affected by atherosclerotic occlusive lesions with or without thrombosis or embolization causing ischaemic symptoms from the gastrointestinal tract. After treatment of an acute event, these patients should be offered both non-pharmacological and pharmacological secondary prevention to reduce risk for future ischaemic arterial manifestations. Patients with mesenteric ischaemia caused by atherosclerosis should be evaluated concerning platelet antiaggregation with low dose aspirin or clopidogrel, and those with cardioembolic disease should be recommended anticoagulant treatment with either warfarin or one of the direct oral anticoagulants (DOAC; apixaban, dabigatran, edoxaban, or rivaroxaban). In all patients, blood pressure should be lowered to <140/90 mmHg with ACE-inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, or thiazide diuretics, and LDL-cholesterol should be kept at <1.8 mmol/l, preferably with statins. If present, diabetes should be treated aiming at good metabolic control, and all smokers should be recommended cessation.