Antithrombotic treatment of asymptomatic carotid atherosclerosis: a medical dilemma

Area of Science:

• Cardiology
• Vascular Medicine
• Preventive Medicine

Background:

• Carotid artery atherosclerosis (CAAS) is frequently detected in asymptomatic individuals undergoing cardiovascular (CV) risk assessment.
• Aspirin is considered for primary CV prevention, but its use in patients with CAAS is controversial.
• CAAS is associated with CV events, yet its status as an independent risk factor remains debated.

Purpose of the Study:

• To review the prognostic significance of asymptomatic CAAS for major CV events.
• To evaluate the effectiveness of antithrombotic agents, specifically aspirin, in this patient population.

Main Methods:

• Systematic review of existing literature.
• Analysis of studies investigating the association between asymptomatic CAAS and CV events.
• Evaluation of data on antithrombotic agent use in patients with CAAS.

Main Results:

• Asymptomatic CAAS is linked to an increased risk of CV events.
• The presence of CAAS alone is not a sufficient indication for primary antithrombotic prophylaxis.
• Evidence does not universally support aspirin use solely based on asymptomatic CAAS detection.

Conclusions:

• Asymptomatic carotid artery atherosclerosis detection should not directly trigger primary prophylaxis with antithrombotic drugs.
• The decision to prescribe aspirin for primary prevention in patients with CAAS requires a thorough assessment of individual CV and bleeding risks.
• Personalized risk-benefit analysis is crucial for managing antithrombotic therapy in asymptomatic CAAS patients.