Consensus antithrombotic prophylaxis of vascular incidents in patients with manifest atherosclerotic vascular diseases. Central Guidance Organization for Peer Review

: The consensus on antithrombotic prophylaxis of vascular incidents in patients with manifest atherosclerotic vasculopathy was preceded by a systematic classification of results from relevant articles according to 'evidential value': from randomized prospective trials of sufficient quality and size, via less adequate or non-randomized trials to the current opinion in the Netherlands. The principal advice was to prescribe antithrombotic prophylaxis, mostly acetylsalicylic acid, for patients with manifest atherosclerotic vasculopathy (in head, heart and (or) legs). With regard to the question what drug should be preferred for patients with intermittent claudication, no consensus could be reached for lack of adequate research. Acetylsalicylic acid is not more effective in higher than in lower doses, but in higher doses it has more side effects; therefore lower doses are preferred: 80-100 mg per day, and for neurological indications, 30 mg or more per day. Use of coumarin derivates is only to be preferred in patients with atrial fibrillation who have suffered a TIA or a non-crippling cerebral infarction, in patients with atrial fibrillation and a cardiac disorder such as large myocardial infarction or a left ventricular aneurysm, and in patients who have undergone a cardiac valve operation. Since the proportion of pros and cons of antithrombotic prophylaxis may change during a patient's life, the indication should be reconsidered periodically.