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• W4328105013 abstract "The first recommendation in the 2017 European Society for Vascular Surgery (ESVS) and European Society of Cardiology Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases highlighted the importance of a multidisciplinary approach to vascular disease.1Aboyans V. Ricco J.B. Bartelink M.E.L. Björck M. Brodmann M. Cohnert T. et al.Editor's Choice – 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS).Eur J Vasc Endovasc Surg. 2018; 55: 305-368Abstract Full Text Full Text PDF PubMed Scopus (553) Google Scholar The ESVS has now taken this concept even further by publishing its 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases.2Twine C.P. Kakkos S.K. Aboyans V. Baumgartner I. Behrendt C.-A. Bellmunt-Montoya S. et al.Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 clinical practice guidelines on antithrombotic therapy for vascular diseases.Eur J Vasc Endovasc Surg. 2023; 65: 627-689Abstract Full Text Full Text PDF Scopus (1) Google Scholar These guidelines, compiled by a multidisciplinary group and published in a surgical journal, illustrate the high degree of integration that has already been achieved in vascular care. The guidelines comprise not only recommendations on antithrombotic treatment in both stable and unstable atherosclerotic vascular disease in all vascular beds (with the exception of coronary and intracerebral vessels) but also on antithrombotic treatment in aneurysmal disease, thrombosis in deep and superficial veins, and more rare conditions such as arterial dissections, Behçet disease, Buerger’s disease, and vascular malformations. Furthermore, special recommendations are given regarding patients with underlying conditions potentially affecting treatment, such as chronic kidney disease, cancer, and antiphospholipid antibodies. In some cases where evidence was missing, such as indications for platelet function testing, assessment of bleeding risk, antiplatelet therapy in aneurysmal disease, and aspects on vascular access, separate validations, systematic reviews, or meta-analyses were performed by the writing committee. The importance of individual bleeding risk assessment in all patients before therapy was highlighted in the first recommendation, and the reader is introduced to a newly developed score for the assessment of bleeding risk in patients with symptomatic lower extremity arterial disease: the OAC3PAD.3Behrendt C.A. Kreutzburg T. Nordanstig J. Twine C.P. Marschall U. Kakkos S. et al.The OAC3-PAD risk score predicts major bleeding events one year after hospitalisation for peripheral artery disease.Eur J Vasc Endovasc Surg. 2022; 63: 503-510Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar,4Peters F. Behrendt C.A. External Validation of the OAC3-PAD risk score to predict major bleeding events using the prospective GermanVasc cohort study.Eur J Vasc Endovasc Surg. 2022; 64: 429-430Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar However, this score is yet to be externally validated, and the discussion regarding the proper definitions of both high risk of bleeding and high risk of ischaemic events is therefore likely to continue. These definitions remain highly relevant, for example when choosing the proper antithrombotic regimen in patients with chronic symptomatic lower extremity arterial disease, and despite remaining uncertainties the clinician will find lots of valuable information in the guidelines to support their choice for the individual patient. Several other guidelines cover different areas of this extensive field, and the currently presented updated recommendations must be compared with previously issued guidelines. For example, the previous ESVS recommendation on one month of double antiplatelet therapy (DAPT) with aspirin and clopidogrel after infrainguinal stent implantation1Aboyans V. Ricco J.B. Bartelink M.E.L. Björck M. Brodmann M. Cohnert T. et al.Editor's Choice – 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS).Eur J Vasc Endovasc Surg. 2018; 55: 305-368Abstract Full Text Full Text PDF PubMed Scopus (553) Google Scholar has been downgraded from class I level B to class IIb level C, and cilostazol is no longer mentioned in this context. The 2019 ESVS recommendation regarding antiplatelet therapy in patients with abdominal aortic aneurysms5Wanhainen A. Verzini F. Van Herzeele I. Allaire E. Bown M. Cohnert T. et al.Editor’s Choice – European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms.Eur J Vasc Endovasc Surg. 2019; 57: 8-93Abstract Full Text Full Text PDF PubMed Scopus (1280) Google Scholar has been downgraded from class IIa level B to class IIb level C. However, the indications for direct acting oral anticoagulants (DOAC) in cancer associated venous thromboembolism have been expanded compared with those provided in the 2021 ESVS Guidelines for Management of Venous Thrombosis, as new evidence and experience have been collected.6Kakkos S.K. Gohel M. Baekgaard N. Bauersachs R. Bellmunt S. Black S. et al.Editor’s Choice – European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis.Eur J Vasc Endovasc Surg. 2021; 61: 9-82Abstract Full Text Full Text PDF PubMed Scopus (190) Google Scholar The use of a DOAC in these patients is now supported by a class I level A recommendation, provided that the risk of gastrointestinal or genitourinary bleeding is low. Regarding the much debated choice of antithrombotic treatment after endovascular intervention for lower extremity arterial disease, the combination of aspirin 75 – 100 mg daily combined with rivaroxaban 2.5 mg twice daily in patients without increased bleeding risk is awarded a class IIa level B recommendation, based on the results of the VOYAGER trial.7Bonaca M.P. Bauersachs R.M. Anand S.S. Debus E.S. Nehler M.R. Patel M.R. et al.Rivaroxaban in peripheral artery disease after revascularization.N Engl J Med. 2020; 382: 1994-2004Crossref PubMed Scopus (401) Google Scholar Consideration of a 1 – 6 month course of DAPT with 75 mg aspirin and 75 mg clopidogrel daily in this situation has been downgraded as mentioned above. This is based on consensus only, as evidence is lacking. Another grey area is how to handle patients with a chronic indication for full dose anticoagulation after endovascular procedures. The class IIb level C recommendation that the addition of single antiplatelet therapy may be considered for a maximum of three months in such cases is based on consensus only, highlighting the need for new studies in this field. Other areas in which the need for further research is highlighted are antithrombotic treatment for carotid interventions, visceral arterial disease, and venous stenting. Furthermore, the authors acknowledge the need for the standardisation of future research regarding outcomes and methods for bleeding risk assessment. Most patients seen in the daily practice of both vascular surgeons and physicians fulfil the indications for some kind of antithrombotic treatment, and these new guidelines will help facilitate proper decision making for all colleagues involved in vascular care, irrespective of specialty.2Twine C.P. Kakkos S.K. Aboyans V. Baumgartner I. Behrendt C.-A. Bellmunt-Montoya S. et al.Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 clinical practice guidelines on antithrombotic therapy for vascular diseases.Eur J Vasc Endovasc Surg. 2023; 65: 627-689Abstract Full Text Full Text PDF Scopus (1) Google Scholar Furthermore, this indispensable resource should be used in vascular education and considered when national and local guidelines are revised in the future." @default.
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• W4328105013 title "The European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases: An Indispensable Resource in Vascular Care" @default.
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