The following are key points to remember about this 2021 European Society of Cardiology (ESC) consensus document on antithrombotic therapies in aortic and peripheral arterial diseases:

1. Antithrombotic therapy is a pillar of optimal medical treatment for patients with aortic and/or peripheral artery disease (PAD), who are at very high cardiovascular risk.
2. For patients with asymptomatic carotid artery stenosis, long-term antiplatelet therapy with aspirin or clopidogrel is recommended.
3. For patients with symptomatic carotid artery stenosis, dual antiplatelet therapy (DAPT; aspirin plus clopidogrel or ticagrelor) is recommended shortly after a minor stroke, transient ischemic attack, or carotid stenting.
4. Long-term, very low-dose rivaroxaban plus aspirin may be proposed for patients with asymptomatic carotid artery stenosis who are at very high risk of cardiovascular complications (e.g., polyvascular disease).
5. For patients with severe or complex aortic plaque, single antiplatelet therapy is recommended. Following an embolic event, DAPT can be considered.
6. There is no validated long-term antithrombotic therapy for patients after an acute aortic syndrome (e.g., acute aortic dissection). Long-term single antiplatelet therapy is recommended after endovascular aortic repair (both abdominal and thoracic). Anticoagulation after this procedure has been associated with higher rates of complications.
7. While there is no benefit to antiplatelet therapy in patients with asymptomatic lower extremity PAD, those with symptomatic PAD are recommended to use at least single antiplatelet therapy (clopidogrel preferred over aspirin). DAPT is not recommended.
8. For high-risk patients and those undergoing revascularization (surgical or endovascular) for lower extremity PAD, very low-dose rivaroxaban plus aspirin can be used if the risk of bleeding is sufficiently low.
9. For patients with atherosclerotic renal or mesenteric artery stenosis, single antiplatelet therapy is recommended. DAPT for at least 1 month is recommended after stenting.
10. For patients with an indication for treatment-dose anticoagulation (e.g., atrial fibrillation), patients with chronic PAD should not use concomitant antiplatelet therapy unless percutaneous revascularization was performed, or they are at high thrombotic risk.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and Vascular Medicine

Keywords: Aneurysm, Dissecting, Anticoagulants, Aspirin, Atrial Fibrillation, Cardiac Surgical Procedures, Carotid Stenosis, Constriction, Pathologic, Endovascular Procedures, Fibrinolytic Agents, Hemorrhage, Ischemic Attack, Transient, Myocardial Revascularization, Peripheral Arterial Disease, Primary Prevention, Platelet Aggregation Inhibitors, Risk Factors, Stroke, Thrombosis, Vascular Diseases

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