Key result
Rivaroxaban plus aspirin cuts stroke ~44% and lowers mortality versus aspirin alone in CAD.
Why the study?
The most efficacious anticoagulant intervention for patients with CAD is not clearly defined, and a lack of integrated comparisons of available treatments limits clinical decision-making.
Meta-Analysis (n=118,870)
Effect estimate: OR 0.56 (95% CI 0.48-0.66)
Supports low-dose rivaroxaban plus aspirin in CAD; extends RCT evidence via network synthesis.
BACKGROUND: The most efficacious anticoagulant intervention for people with coronary artery disease (CAD) is still not clearly defined, highlighting the need for a comprehensive assessment of the available alternatives. Previous studies have assessed individual treatments, but a lack of integrated comparisons limits clinical decision-making. This investigation seeks to check how safe and effective a range of anticoagulant therapies for individuals suffering from CAD are through a network meta-analysis. METHODS: A comprehensive study and NMA were performed, including data from Embase, MEDLINE, PubMed, and WoS through May 20, 2024. 11 RCTs were incorporated, encompassing 118,870 individuals suffering from CAD. Outcome measures focused on stroke, myocardial infarction, all-cause mortality, cardiovascular mortality, and bleeding risks. Effect sizes for categorical variables were measured by odds ratios (OR) with 95% CrIs. RESULTS: The administration of Rivaroxaban at a dosage of 2.5 mg BID, in conjunction with Aspirin at 100 mg OD, has been shown to markedly diminish the incidence of stroke (OR: 0.56, 95% CrI: 0.48 to 0.66), myocardial infarction (OR: 0.72, 95% CrI: 0.57 to 0.90), all-cause mortality (OR: 0.77, 95% CrI: 0.60 to 0.98), and cardiovascular mortality (OR: 0.77, 95% CrI: 0.66 to 0.90) however, there is an elevated risk of bleeding. The administration of Rivaroxaban in dose of 2.5 mg BID demonstrated elevated SUCRA rankings in terms of both efficacy and safety, indicating a well-rounded profile. CONCLUSION: The administration of Rivaroxaban in dose of 2.5 mg BID, in conjunction with Aspirin at 100 mg OD, demonstrates efficacy in mitigating thrombotic occurrences among individuals with CAD; however, it concomitantly elevates the risk of bleeding complications. Administering Rivaroxaban in dose of 2.5 mg two times per day stands as a plausible alternative, achieving a commendable equilibrium between efficacy and safety. This study helps fill an important evidence gap in guiding optimal anticoagulant strategies for CAD patients.
No takes yet. Share an insight, caveat, or question.
Cui et al. (2025) conducted a meta-analysis in Coronary artery disease (n=118,870). Rivaroxaban plus Aspirin vs. Aspirin 100 mg OD was evaluated on Stroke (OR 0.56, 95% CI 0.48-0.66). Rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily significantly reduced stroke (OR 0.56) and all-cause mortality (OR 0.77) compared to aspirin alone in coronary artery disease patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: