Thromb Haemost 2019; 119(04): 576-585
DOI: 10.1055/s-0039-1678527
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Management of Patients with Asymptomatic and Symptomatic Carotid Artery Disease: Update on Anti-Thrombotic Therapy

Daniele Pastori
1  I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
,
John W. Eikelboom
2  Department of Medicine, McMaster University, Hamilton, Ontario, Canada
,
Sonia S. Anand
3  Department of Medicine, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
,
Manesh Raman Patel
4  Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, United States
,
Jean-Francois Tanguay
5  Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
,
Jean-Baptiste Ricco
6  Department of Clinical Research and Innovation (DRCI), University Hospital of Poitiers, Poitiers, France
,
Eike Sebastian Debus
7  Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany
,
Lucia Mazzolai
8  Division of Angiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
,
Rupert Bauersachs
9  Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany
10  Center of Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
,
Peter Verhamme
11  Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
,
Jackie Bosch
12  Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
13  School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
,
Sigrid Nikol
14  Department of Clinical and Interventional Angiology, Asklepios Klinik St. Georg, Hamburg, Germany
,
Mark Nehler
15  CPC Research, Aurora, Colorado, United States
,
Victor Aboyans
16  Department of Cardiology, Dupuytren University Hospital, 2, Martin Luther King Ave, Limoges, France
17  Research Unit INSERM 1094, Faculté de médecine de Limoges, Limoges, France
,
Francesco Violi
1  I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
› Author Affiliations
Further Information

Publication History

12 October 2018

21 December 2018

Publication Date:
31 January 2019 (eFirst)

Abstract

The most common causes of ischaemic stroke are represented by carotid artery atherosclerotic disease (CAAD) and atrial fibrillation. While oral anticoagulants substantially reduce the incidence of thromboembolic stroke (< 1%/year), the rate of ischaemic stroke and other cardiovascular disease events in patients with CAAD remains high, ranging from 8.4 to 18.1 events per 100 patient-years. Similar to any other atherosclerotic disease, anti-thrombotic therapies are proposed for CAAD to reduce stroke and other cardiovascular events. The 2017 European Society of Cardiology (ESC)/European Society for Vascular Surgery (ESVS) guidelines recommend for patients with asymptomatic CAAD ≥60% the use of aspirin 75 to 100 mg once daily or clopidogrel 75 mg once daily at the exception of patient at very high bleeding risk. For patients with symptomatic CAAD ≥50%, the use of aspirin 75 to 100 mg once daily or clopidogrel 75 mg once daily is recommended. New perspectives for anti-thrombotic therapy for the treatment of patients with CAAD come from the novel dual pathway strategy combining a low-dose anticoagulant (i.e. rivaroxaban) and aspirin that may help reduce long-term ischaemic complications in patients with CAAD. This review summarizes current evidence and recommendations for the anti-thrombotic management of patients with symptomatic or asymptomatic CAAD or those undergoing carotid revascularization.