Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy

Aboyans, Victor; Bauersachs, Rupert; Mazzolai, Lucia; Brodmann, Marianne; Rodriguez Palomares, Jose F.; Debus, Sebastian; Collet, Jean-Philippe; Drexel, Heinz; Espinola-Klein, Christine; Lewis, Basil S.; Roffi, Marco; Sibbing, Dirk; Sillesen, Henrik; Stabile, Eugenio; Schlager, Oliver und De Carlo, Marco (2021): Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy. In: European Heart Journal, Bd. 42, Nr. 39: S. 4013-4024

Abstract

The aim of this collaborative document is to provide an update for clinicians on best antithrombotic strategies in patients with aortic and/or peripheral arterial diseases. Antithrombotic therapy is a pillar of optimal medical treatment for these patients at very high cardiovascular risk. While the number of trials on antithrombotic therapies in patients with aortic or peripheral arterial diseases is substantially smaller than for those with coronary artery disease, recent evidence deserves to be incorporated into clinical practice. In the absence of specific indications for chronic oral anticoagulation due to concomitant cardiovascular disease, a single antiplatelet agent is the basis for long-term antithrombotic treatment in patients with aortic or peripheral arterial diseases. Its association with another antiplatelet agent or low-dose anticoagulants will be discussed, based on patient's ischaemic and bleeding risk as well therapeutic paths (e.g. endovascular therapy). This consensus document aims to provide a guidance for antithrombotic therapy according to arterial disease localizations and clinical presentation. However, it cannot substitute multidisciplinary team discussions, which are particularly important in patients with uncertain ischaemic/bleeding balance. Importantly, since this balance evolves over time in an individual patient, a regular reassessment of the antithrombotic therapy is of paramount importance. [GRAPHICS] Summary of optimal and alternative antithrombotic strategies in patients with peripheral arterial disease. In-a the absence of any other vascular disease. (b)The addition of clopidogrel on top of low-dose aspirin and rivaroxaban can be decided case by case, taking into consideration type and length of stent, disease severity, and bleeding risk. If clopidogrel is added, it should be limited to 1 month to limit bleeding complications.(100 c)There are no data for a head-tohead comparison between R+A vs. A+C strategies. The latter has been empirically implemented and recommended for endovascular therapy,(1) while the R+A has been recently assessed in a randomized trial.(80) Also, the R+A strategy can be prolonged beyond the post-revascularization period with benefits on MACE and MALE.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0195-668X
• Sprache: Englisch