From the Guidelines
Aspirin should be continued for patients who have undergone Endovascular Aneurysm Repair (EVAR) to prevent thromboembolic complications and reduce the risk of cardiovascular events. The typical recommendation is to continue low-dose aspirin (75-100 mg daily) indefinitely following EVAR, as this antiplatelet therapy helps prevent thrombus formation on the endograft surface and decreases the chance of graft occlusion 1.
Benefits of Aspirin Therapy
- Reduces the risk of thromboembolic complications
- Decreases the chance of graft occlusion
- Provides protection against cardiovascular events, which is particularly important since patients requiring EVAR often have underlying cardiovascular disease
Considerations for Aspirin Therapy
- The benefit of continued aspirin therapy generally outweighs the bleeding risk for most patients
- The decision should be individualized based on the patient's specific bleeding risk factors, comorbidities, and other medications
- In some cases, dual antiplatelet therapy might be recommended initially (typically aspirin plus clopidogrel for 1-3 months), followed by lifelong aspirin monotherapy
Monitoring and Follow-up
- Regular follow-up imaging is essential to monitor the repair regardless of antiplatelet regimen
- Patients should be closely monitored for signs of bleeding or other complications, and the aspirin dose should be adjusted as needed to minimize the risk of adverse events 1.
From the Research
Aspirin Continuation for EVAR
- The decision to continue aspirin for Endovascular Aortic Repair (EVAR) is based on several factors, including the patient's risk of cardiovascular events and the presence of peripheral arterial disease (PAD) 2.
- Aspirin is commonly used in conjunction with other anti-platelet agents, such as clopidogrel, to prevent complications such as graft thrombosis and limb ischemia 2, 3.
- The use of aspirin in patients undergoing EVAR has been shown to reduce the risk of cardiovascular events, including myocardial infarction and ischemic stroke 2, 3.
- However, the optimal duration of aspirin therapy after EVAR is not well established, and further studies are needed to determine the best approach 2, 3.
Complications of EVAR
- EVAR is associated with several complications, including limb thrombosis, graft thrombosis, and cardiovascular events 4, 5, 6.
- Limb thrombosis is a common complication of EVAR, and can be managed with thrombectomy, stent placement, and other interventions 5, 6.
- The risk of limb thrombosis is higher in patients with smaller iliac arteries and those who smoke 6.
- The use of clopidogrel in conjunction with aspirin may modify the efficacy and safety of rivaroxaban, a factor Xa inhibitor, in patients undergoing EVAR 3.
Medical Management of EVAR
- The medical management of patients undergoing EVAR includes anti-platelet therapy, statins, and other medications to reduce the risk of cardiovascular events 2, 3.
- The choice of anti-platelet agent and the duration of therapy should be individualized based on the patient's risk factors and medical history 2, 3.
- Further studies are needed to determine the optimal medical management strategy for patients undergoing EVAR 2, 3.