From the Guidelines
Aspirin has a limited role in the management of aortic dissection, and its use is generally considered on a case-by-case basis, taking into account the patient's individual risk factors and concomitant conditions.
Key Considerations
- The use of low-dose aspirin in patients with aortic aneurysms is uncertain, with conflicting results from observational studies regarding aneurysm growth 1.
- In patients with abdominal aortic aneurysms (AAA) and concomitant atheroma and/or penetrating aortic ulcer (PAU), low-dose aspirin may be considered, unless contraindicated, to reduce the risk of cardiovascular events 1.
- Aspirin is not associated with a higher risk of AAA rupture but could worsen prognosis in cases of rupture 1.
- The 2022 ACC/AHA guideline for the diagnosis and management of aortic disease recommends considering low-dose aspirin in patients with AAA and concomitant atheroma and/or PAU, unless contraindicated, with a Class IIb, Level C-LD recommendation 1.
Clinical Implications
- The decision to use aspirin in patients with aortic dissection should be individualized, taking into account the patient's risk factors, such as concomitant coronary artery disease, and the potential benefits and risks of antiplatelet therapy.
- Further study is needed to determine the efficacy of antiplatelet therapy in aortic dissection and to guide clinical decision-making 1.
From the Research
Role of Aspirin in Aortic Dissection Management
- Aspirin (acetylsalicylic acid) is used as an anti-thrombotic agent in the management of aortic dissection 2.
- A study from 1992 reported the use of aspirin in combination with heparin as antithrombotic treatment for a patient with acute type II aortic dissection 3.
- In the context of thoracic endovascular aortic repair (TEVAR) for type B aortic dissections, aspirin is used as part of antiplatelet therapy, with single antiplatelet therapy (SAPT) being associated with a lower risk of bleeding compared to dual antiplatelet therapy (DAPT) 4.
- The role of aspirin in slowing the progression of abdominal aortic aneurysms (AAAs) has been investigated, with some studies suggesting a potential benefit 5, while others have found no association between low-dose aspirin use and reduced risk of mortality or exacerbation in different aortic aneurysms 6.
Aspirin Therapy in Aortic Dissection
- Aspirin is used to prevent thrombotic events in patients with aortic dissection, particularly in those undergoing TEVAR 4.
- The optimal antiplatelet therapy after revascularization of the left subclavian artery during TEVAR is still uncertain, with both SAPT and DAPT being used 4.
- Aspirin has been shown to be effective in slowing the progression of AAAs, with a slower mean annualized change in aneurysm diameter and lower odds of rapid aneurysm progression compared to patients not taking aspirin 5.
Clinical Outcomes
- The use of aspirin in patients with aortic dissection has been associated with a lower risk of bleeding, particularly in those undergoing TEVAR 4.
- Aspirin use has not been shown to be associated with an increased risk of major bleeding or composite outcome (dissection, rupture, and repair) in patients with AAAs 5.
- The long-term outcome of patients with aortic aneurysms taking low-dose aspirin has been investigated, with some studies finding no association between aspirin use and reduced risk of mortality or exacerbation 6.