Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC
Victor Aboyans1, Rupert Bauersachs2, Lucia Mazzolai3
1Department of Cardiology, Dupuytren University Hospital, and INSERM 1094 & IRD, University of Limoges, 2, Martin Luther King ave, 87042, Limoges, France.
European Heart Journal
|July 19, 2021
Summary
For patients with aortic or peripheral arterial diseases, a single antiplatelet agent is the foundation of antithrombotic therapy. Treatment adjustments depend on individual risks and clinical context, requiring regular reassessment.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Pharmacology
Background:
- Antithrombotic therapy is crucial for managing patients with aortic and peripheral arterial diseases, who are at high cardiovascular risk.
- Clinical practice guidelines need updates based on recent evidence in antithrombotic strategies for these patient populations.
- Evidence for antithrombotic therapies in aortic and peripheral arterial diseases is less extensive than for coronary artery disease.
Purpose of the Study:
- To provide clinicians with an updated consensus on optimal antithrombotic strategies for patients with aortic and/or peripheral arterial diseases.
- To guide antithrombotic therapy decisions based on arterial disease localization and clinical presentation.
- To emphasize the importance of individualized treatment plans and regular reassessment of antithrombotic therapy.
Main Methods:
- Consensus document development based on recent clinical trial evidence.
- Review of antithrombotic therapies including single antiplatelet agents, dual antiplatelet therapy, and low-dose anticoagulation.
- Consideration of patient-specific factors such as ischemic and bleeding risk, and therapeutic pathways like endovascular therapy.
Main Results:
- A single antiplatelet agent is recommended as the cornerstone of long-term antithrombotic treatment in the absence of indications for chronic oral anticoagulation.
- Combination therapy (dual antiplatelet or low-dose anticoagulation) may be considered based on a careful balance of ischemic and bleeding risks.
- Multidisciplinary team discussions are essential for managing complex cases with uncertain risk-benefit profiles.
Conclusions:
- Clinicians should tailor antithrombotic strategies to individual patient profiles, considering disease location, clinical presentation, and evolving risk factors.
- Regular reassessment of the ischemic/bleeding balance is paramount to optimize long-term antithrombotic therapy.
- This consensus provides a framework for antithrombotic management, underscoring the need for personalized care and expert consultation.
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
83
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
83
01:26Atherosclerosis III: Management
82
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
82
01:29Venous Thrombosis III: Interprofessional Care
68
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
68
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
113
Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
113
01:23Atherosclerosis IV: Nursing Management
104
Nursing management for a patient with arteriosclerosis involves a comprehensive approach focusing on lifestyle modification, disease monitoring, education, and symptomatic care. Here is an overview of effective nursing strategies:Assessment and Monitoring: Initial and ongoing assessments are crucial. Nurses must document the patient's medical history, including any hypertension, diabetes, hyperlipidemia, and other cardiovascular diseases. Assessments also cover family history and lifestyle...
104
01:27Coronary Artery Disease V: Interprofessional Care
74
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
74