From the Guidelines
Antiplatelet therapy is recommended for patients with Fibromuscular Dysplasia (FMD), particularly those with ischemic stroke or TIA, with aspirin 81–325 mg daily, clopidogrel 75 mg daily, or aspirin + dipyridamole 25/200 mg daily being suitable options. The choice of antiplatelet agent should be based on patient tolerance and specific clinical circumstances, with aspirin being a common first-line choice due to its efficacy and safety profile 1. Key considerations in the management of FMD patients on antiplatelet therapy include:
- Monitoring for signs of thromboembolic events or disease progression
- Adjusting therapy based on clinical response and side effects
- Ensuring blood pressure control to reduce the risk of cardiovascular complications
- Regular vascular imaging to assess disease progression and guide management decisions In cases where patients have specific conditions such as extracranial artery dissection or carotid web, antiplatelet therapy is also recommended, highlighting the importance of tailored approaches based on individual patient factors 1. For patients with FMD and ischemic stroke or TIA, the goal of antiplatelet therapy is to prevent further thromboembolic events, thereby reducing morbidity and mortality, and improving quality of life. The duration of antiplatelet therapy in FMD patients is typically long-term, unless contraindications arise, emphasizing the need for ongoing monitoring and management to balance the benefits and risks of therapy 1.
From the Research
Recommendations for Antiplatelet Therapy in FMD Patients
- The use of antiplatelet agents in patients with Fibromuscular Dysplasia (FMD) is a topic of ongoing debate, with some studies suggesting its potential benefits 2, 3.
- A study published in the Journal of Clinical Hypertension found that 72.9% of patients with FMD were using antiplatelet agents, with aspirin being the most commonly prescribed 2.
- However, the evidence to support the use of lifelong antiplatelet therapy in all FMD patients is uncertain, and it may be more appropriate to use antiplatelet agents only in patients with a clear indication after individual evaluation according to risk factors for thrombotic and thromboembolic complications 2.
- Another study published in the Journal of Vascular Surgery found that 91% of patients with FMD who underwent carotid stenting were receiving dual antiplatelet therapy, with no differences found in perioperative stroke, TIA, or 30-day mortality compared to patients without FMD 4.
- The use of antiplatelet agents in FMD patients may vary based on vascular bed involvement, with isolated renal FMD patients receiving more anti-hypertension medications and cerebrovascular FMD patients receiving more antiplatelet agents 3.
Factors Associated with Antiplatelet Agent Use in FMD Patients
- Older age, history of coronary artery disease, cerebrovascular artery FMD involvement, and previous intervention for FMD are associated with a greater likelihood of antiplatelet agent use in FMD patients 3.
- The use of antiplatelet agents in FMD patients may also depend on the presence of other comorbid conditions, such as hypertension and diabetes 3.
Comparison with Other Conditions
- The use of antiplatelet agents in FMD patients is similar to that in patients with atherosclerotic vascular disease, where antiplatelet therapy with aspirin is a well-established treatment 5.
- However, the efficacy and safety of antiplatelet therapy in FMD patients have not been specifically demonstrated, and further studies are needed to correlate medication use with clinically meaningful patient outcomes 2, 3.