Pharmacological secondary prevention in patients with mesenterial artery atherosclerosis and arterial embolism

Visceral arteries such as the coeliac (CA), superior mesenteric (SMA), and the inferior mesenteric artery (IMA) might be affected by atherosclerotic occlusive lesions with or without thrombosis or embolization causing ischaemic symptoms from the gastrointestinal tract.After treatment of an acute event, these patients should be offered both non-pharmacological and pharmacological secondary prevention to reduce risk for future ischaemic arterial manifestations. Patients with mesenteric ischaemia caused by atherosclerosis should be evaluated concerning platelet antiaggregation with low dose aspirin or clopidogrel, and those with cardioembolic disease should be recommended anticoagulant treatment with either warfarin or one of the direct oral anticoagulants (DOAC; apixaban, dabigatran, edoxaban, or rivaroxaban). In all patients, blood pressure should be lowered to <140/90 mmHg with ACE-inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, or thiazide diuretics, and LDL-cholesterol should be kept at <1.8 mmol/l, preferably with statins. If present, diabetes should be treated aiming at good metabolic control, and all smokers should be recommended cessation.