From the Guidelines
Arterial thrombosis is primarily caused by atherosclerosis, a chronic inflammatory disease where plaque builds up inside arterial walls, and management focuses on addressing underlying conditions through lifestyle modifications, antiplatelet therapy, anticoagulants, statins, and blood pressure and diabetes control. The pathogenesis of arterial thrombosis involves the rupture of an atherosclerotic plaque, exposing thrombogenic material that activates platelets and the coagulation cascade, leading to thrombus formation 1. Other underlying conditions that contribute to arterial thrombosis include:
- Hypertension
- Diabetes mellitus
- Smoking
- Hyperlipidemia
- Obesity These conditions damage the endothelial lining of blood vessels, promoting platelet adhesion and aggregation. Certain hypercoagulable states like antiphospholipid syndrome, protein C or S deficiency, and factor V Leiden mutation also increase risk 1. Atrial fibrillation is a significant risk factor for arterial thrombosis, particularly in the cerebral circulation, as it allows blood to pool and clot in the heart chambers.
In terms of management, antiplatelet therapy (aspirin, clopidogrel) and anticoagulants (warfarin, DOACs) are essential for preventing arterial thrombotic events. Statins are also crucial for managing hyperlipidemia, and blood pressure and diabetes control are vital for preventing arterial thrombosis 1. Early identification and treatment of these underlying conditions are essential for preventing arterial thrombotic events like myocardial infarction and ischemic stroke. In cases of acute iliac artery ischemia, prompt restoration of distal blood flow is crucial, and treatment options include catheter-directed thrombolysis, mechanical thrombectomy, and surgical approaches 1.
From the Research
Arterial Thrombosis Underlying Disease
- Arterial thrombosis is a major complication of atherosclerosis, which involves structural changes to the intima and media of medium- and large-sized arteries 2.
- Atherothrombosis is a generalized disease process that affects different vascular territories, leading to clinical manifestations such as coronary heart disease, peripheral arterial disease, and cerebral ischemia 2, 3.
- The incidence of cerebrovascular events is high, with 2,900 events per million inhabitants per year, consisting of 500 transient ischemic attacks and 2,400 strokes, of which 75% are first-ever strokes 2.
Risk Factors and Prevention
- Optimal management of risk factors for atherothrombosis, carotid surgery, and antiplatelet therapy are crucial for preventing arterial thrombosis 2.
- Antiplatelet agents, such as aspirin and clopidogrel, are effective in reducing the risk of further ischemic events in patients with atherothrombosis 2, 4.
- The dual pathway concept, which combines antiplatelet and anticoagulation therapy, has shown promise in reducing the risk of recurrent ischemic events in patients with stable atherosclerotic disease 4, 5.
Treatment Options
- Rivaroxaban, a direct factor Xa inhibitor, has been shown to be effective in reducing the risk of recurrent ischemic events when combined with aspirin in patients with stable atherosclerotic disease 4, 5.
- However, the use of rivaroxaban has been associated with an increased risk of major ischemic or hemorrhagic events compared to apixaban in patients with atrial fibrillation 6.
- The choice of treatment should be individualized, taking into account the patient's risk factors, comorbidities, and potential benefits and risks of each treatment option 5, 6.