Can a patient with a prior Acute Vascular Accident (AVC) or Cerebrovascular Accident (CVA) and presenting with a type 2 aortic dissection, who is stable, continue taking Aspirin (acetylsalicylic acid)?

From the Guidelines

In a patient with a prior Acute Vascular Accident (AVC) or Cerebrovascular Accident (CVA) and presenting with a stable type 2 aortic dissection, aspirin (acetylsalicylic acid) therapy can be continued, as the benefits of antiplatelet therapy in preventing further ischemic strokes outweigh the risks, according to the guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack 1.

The management of aortic dissection involves controlling blood pressure and preventing further complications, but the use of antiplatelet agents like aspirin is crucial in patients with a history of stroke or TIA to reduce the risk of recurrent stroke.

• The guidelines recommend antiplatelet agents rather than oral anticoagulation to reduce the risk of recurrent stroke and other cardiovascular events in patients with noncardioembolic ischemic stroke or TIA 1.
• Aspirin is considered an acceptable option for initial therapy, with a recommended dose of 50 to 325 mg/d 1.
• The combination of aspirin and extended-release dipyridamole, as well as clopidogrel, are also acceptable options, but the choice of antiplatelet agent should be individualized based on patient risk factor profiles, tolerance, and other clinical characteristics 1.

In the context of a stable type 2 aortic dissection, the primary concern is to manage the dissection and prevent further complications, while also considering the patient's history of stroke or TIA and the need for antiplatelet therapy.

• Aggressive blood pressure control with beta-blockers and other antihypertensives is crucial in managing the aortic dissection 1.
• The use of antiplatelet agents like aspirin should be continued, as the benefits of preventing further ischemic strokes outweigh the risks, and the risk of bleeding complications can be managed with careful monitoring and adjustment of antihypertensive therapy 1.

Overall, the decision to continue aspirin therapy in a patient with a prior AVC or CVA and presenting with a stable type 2 aortic dissection should be made on a case-by-case basis, taking into account the individual patient's risk factors, medical history, and current clinical status, and in consultation with both cardiology and vascular surgery specialists.

From the Research

Patient Considerations

• A patient with a prior Acute Vascular Accident (AVC) or Cerebrovascular Accident (CVA) and presenting with a type 2 aortic dissection, who is stable, may have specific treatment considerations.
• The use of Aspirin (acetylsalicylic acid) in such patients is a topic of interest, given its antiplatelet properties.

Aspirin Therapy in Aortic Dissection

• A study published in 2017 2 found that long-term oral low-dose aspirin was safe for patients with both Stanford Type B aortic dissection and coronary heart disease who underwent endovascular aortic repair (EVAR).
• The study also found that dual-antiplatelet therapy (DAPT, aspirin + clopidogrel) showed no increase in hemorrhage, endoleak, recurrent dissection, death, and myocardial infarction in patients who underwent both EVAR and percutaneous coronary intervention (PCI).
• However, other studies do not directly address the use of aspirin in patients with a prior AVC or CVA and a type 2 aortic dissection.

Management of Aortic Dissection

• Aortic dissection is a highly treatable condition, with treatment options including medical, surgical, or endovascular approaches 3.
• Diligent control of blood pressure is crucial in managing aortic dissection, with the goal of preventing target organ damage and stopping the progression of dissection 3.
• The use of beta-blockers is a common approach in managing aortic dissection, although their effectiveness and potential risks must be carefully considered 4, 5.

Specific Considerations for Aspirin Use

• The decision to continue aspirin therapy in a patient with a prior AVC or CVA and a type 2 aortic dissection should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.
• While the available evidence suggests that aspirin may be safe in certain patients with aortic dissection, it is essential to weigh the potential benefits against the risks of bleeding and other complications.