The Swiss Society of Angiology advises against long-term use of aspirin in patients with no evidence of cardiovascular disease. This makes a clear statement on this controversial topic. The remaining four recommendations address further critical issues relating to arterial, venous and lymphatic diseases.
The international “Choosing Wisely” initiative launched a few years ago aims to correct overuse and misuse in medicine. To this end, the non-profit organization works with specialist associations to draw up lists of five medical measures that are generally unnecessary. The Swiss Society of Angiology (SGA) recently published a top 5 list of frequent but unnecessary investigations or treatments in vascular medicine.
The recommendations at a glance
The list was compiled based on the suggestions of the members of the specialist society and includes the following statements:
1. no antiplatelet drugs such as aspirin (acetylsalicylic acid) in the prevention of cardiovascular diseases.
If there are no indications or no cardiovascular disease is present, long-term use of aspirin should be avoided. The general use of acetylsalicylic acid has no benefit in terms of reducing future cardiovascular disease. Regular use requires a medical, individual benefit and risk assessment.
2. no diagnosis of a circulatory disorder of the arms and legs, for example intermittent claudication or smoker’s leg or atherosclerosis by computer tomography (CT) or magnetic resonance imaging (MRI).
For the diagnosis of a circulatory disorder of the extremities, examination methods such as CT or MRI should be avoided, as these examinations require injections of contrast medium or expose patients to X-rays. If a circulatory disorder is suspected, an ultrasound examination should be performed, which is free of contrast agents and X-rays and is less expensive.
3. no balloon catheter or vascular surgery in the case of symptom-free circulatory disorders of the arms and legs.
Patients with evidence of vascular calcification of the arms and legs but without symptoms should not undergo vascular surgery. Such interventions serve to treat the symptoms, but they do not solve the actual underlying problem of progressive arteriosclerosis.
4. no blood coagulation test for deep vein thrombosis if the cause is known.
Deep vein thrombosis is a very common condition with clear treatments. The search for a congenital coagulation disorder or one that has occurred has no influence on the type and duration of therapy. However, the search for coagulation disorders is useful if there is a family history of thrombosis.
5. no manual lymphatic drainage without additional decongestant treatment with compression measures to maintain lymphoedema.
Manual lymphatic drainage alone does not sufficiently reduce swelling. Therefore, the benefits of this therapy are not given without compression bandages or compression stockings.
List adopted unanimously
The list unanimously approved by the General Assembly of the Society of Angiology Specialists is available online at: www.smartermedicine.ch/de/top-5-listen/angiologie-2024
The Swiss Society of Angiology/Vascular Medicine (SGA) has over 200 members and is particularly concerned with the diagnosis and conservative and invasive treatment of arterial, venous and lymphatic diseases. Further information on the professional association: www.swissvascularmedicine.ch
Source: «Schweizerische Gesellschaft für Angiologie publiziert Top-5-Liste», smarter medicine, Bern, 25.01.2024
HAUSARZT PRAXIS 2024; 19(3): 33
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