From the Guidelines
The latest findings on blood flow research suggest that strategies to improve blood flow by changing the rheological characteristics of the blood or by increasing perfusion pressure are not established as useful and are associated with a risk of serious neurological or cardiovascular complications, as stated in the 2003 guidelines for the early management of patients with ischemic stroke 1.
Key Findings
- The 2015 recommendations for improving and standardizing vascular research on arterial stiffness emphasize the importance of using wave separation analysis to investigate the role of wave reflection in cardiovascular outcomes 1.
- Recent studies have highlighted the limitations of brain slice studies in understanding blood flow regulation, and the need for in vivo validation of candidate mechanisms 1.
- The control of capillary blood flow is complex and involves the deformability of red blood cells, which increases upon deoxygenation, allowing them to pass through narrow capillaries 1.
Implications for Clinical Practice
- The use of non-invasive techniques, such as wave separation analysis, to assess arterial stiffness and wave reflections may provide valuable insights into cardiovascular risk and guide therapeutic decisions 1.
- Interventions that reduce arterial stiffness and wave reflections, such as aerobic exercise training and dietary changes, may have beneficial effects on cardiovascular health 1.
- Further research is needed to fully understand the mechanisms of blood flow regulation and to develop effective therapeutic strategies to improve cardiovascular outcomes.
Future Directions
- The development of new techniques, such as in vivo imaging, may provide further insights into the control of capillary blood flow and its role in cardiovascular health 1.
- The investigation of the effects of different interventions, such as exercise and dietary changes, on arterial stiffness and wave reflections may provide valuable information for the development of therapeutic strategies 1.
From the Research
Latest Findings on Blood Flow Research
- The latest research on blood flow, specifically in patients with peripheral artery disease (PAD), has led to several key findings 2, 3, 4, 5, 6.
- Studies have investigated the efficacy and safety of various antithrombotic treatments, including single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), and the use of direct oral anticoagulants (DOACs) in combination with aspirin 2, 3, 5, 6.
Antithrombotic Treatment in PAD
- Research has shown that in symptomatic PAD patients, SAPT with aspirin or clopidogrel is indicated, although the efficacy of aspirin is controversial 2.
- Clopidogrel may be preferred over aspirin, and ticagrelor has been found to lower the risk of ischemic stroke, but is not superior to clopidogrel in reducing major adverse cardiovascular events and major adverse limb events 2.
- The use of rivaroxaban plus aspirin has been found to reduce the risk of major adverse cardiovascular events and major adverse limb events in PAD patients, although it increases the risk of major bleeding 3, 5, 6.
Sex-Specific Effects of Antithrombotic Treatment
- Studies have also explored the effects of antithrombotic treatment in women and men with PAD, finding that the combination of rivaroxaban and aspirin produces consistent benefits in both women and men, independent of baseline cardiovascular risk 5.
Safety and Efficacy of DOACs in PAD
- The efficacy and safety of DOACs in combination with aspirin have been assessed in patients with symptomatic lower extremity PAD, with findings suggesting that this combination reduces the risk of major adverse limb events, but increases the risk of major bleeding 6.