Antithrombotic therapy in aortic diseases: A narrative review

Abstract

Aortic diseases are a heterogeneous group of disorders, including atherothrombotic conditions like aortic atheroma, cholesterol embolization syndrome, aortic mural thrombus, thrombus within an aneurysm, and large vessel vasculitis. In this review, we provide a summary of the current evidence regarding atherothrombotic diseases of the aorta, focusing on therapeutic avenues. In patients with previous stroke, aortic arch atheroma is recognized as a strong predictor of recurrent atheroembolism, and antiplatelet therapy alone is still associated with a high (11.1%) residual risk of recurrent stroke. In secondary prevention, the use of dual antiplatelet therapy or moderate intensity anticoagulation with warfarin may lower the risk of recurrent stroke at a cost of increased life-threatening bleeding. Thrombi adherent to the aortic wall are generally associated with underlying atherosclerosis or aneurysmal disease. Primary aortic mural thrombus is a rare condition, sometimes related with systemic prothrombotic or inflammatory diseases. Retrospective studies suggest that anticoagulation is beneficial in patients with mobile mural thrombus. The pathogenesis and consequences of thrombus in an aortic aneurysm, or in an endograft following endovascular aneurysm repair, have been studied, but the role of antiplatelet therapy in those two conditions is still unclear and should be driven by general cardiovascular risk prevention. The benefit of anticoagulation to reduce thrombus load is uncertain. Patients with large vessel vasculitis experience increased cardiovascular events secondary to inflammation-driven atherothrombotic processes. Antiplatelet therapy is recommended as part of the therapy for prevention of cardiovascular disease. Anticoagulation with warfarin has shown limited benefit in few retrospective studies.

Morning hypertension is a risk factor of macrovascular events following cerebral infarction

“…The relationship between the use of antiplatelet drugs and statins and the recurrence of cerebral infarction has attracted the attention of many authors. [ 30 , 31 ] Compliance to guidelines and treatments has been shown to be relatively low in China. [ 17 , 18 ] Antiplatelet drugs can decrease platelet aggregation and reduce blood viscosity, alleviating the symptoms of intracranial ischemia.…”

Letter to the Vascular Medicine readership

“…Our first article selected for CME is Antithrombotic Therapy in Aortic Diseases: A Narrative Review by Francois Caron and Sonia Anand, and appears in this issue. 1 For SVM members, the test questions and the ability to claim CME credit are located on the SVM website (www.vascularmed.org). We will run up to two CME review articles per issue, and each article will offer 1 AMA PRA Category 1 Credit™.…”

Wide Spread Arterial and Venous Thrombosis in a Case of Hyperglycemic Hyperosmolar State (HHS)

“…Further imaging identified a thrombus in the aortic arch as well. The number of case reports with a limb-ischemia combined with a proximal aortic thrombus is growing, supposedly due to the development of novel imaging techniques [8,9]. This high-risk phenotype might not be as rare as previously thought.…”