Key result
Rivaroxaban plus aspirin reduces MACE and MALE vs aspirin alone in CAD/PAD but increases major bleeding.
Why the study?
Using single-antiplatelet therapy alone for secondary prevention in patients with stable coronary artery disease and/or peripheral artery disease carries a significant risk of recurrent thrombotic complications.
Does rivaroxaban plus aspirin reduce MACEs and MALEs compared to aspirin alone in patients with stable CAD and/or PAD?
Systematic Review (n=33,959)
Does rivaroxaban plus aspirin reduce MACEs and MALEs compared to aspirin alone in patients with stable CAD and/or PAD?
The combination of rivaroxaban and aspirin is superior to aspirin monotherapy for secondary prevention of MACE and MALE in patients with stable CAD and/or PAD, albeit with an increased risk of major bleeding.
Supports rivaroxaban plus aspirin for MACE/MALE prevention in stable CAD/PAD; confirms and extends RCT evidence despite bleeding risk.
Introduction: Low-dose aspirin or clopidogrel, statins, renin-angiotensin system inhibitors, and beta blockers are the cornerstone therapy for cardiovascular prevention in patients with coronary heart disease. Using only single-antiplatelet therapy for secondary prevention in patients with stable coronary artery disease (SCAD) and/or peripheral artery disease (PAD) has a significant risk of recurrent thrombotic complications. Objective: This systematic review aimed to compare aspirin alone and its combination with rivaroxaban for secondary cardiovascular prevention in patients with SCAD and/or PAD. Methods: The literature search was conducted on PubMed, ClinicalTrials.gov, Cochrane Library, and Google Scholar for articles published from November 2011 to September 2021. An advanced search strategy was used to retrieve relevant studies related to aspirin and/or rivaroxaban use for secondary cardiovascular prevention in patients with SCAD and/or PAD. Records identified from the databases were extracted using a data-abstraction format prepared in Microsoft Excel. Studies' methodological quality was assessed using the Cochrane risk-of-bias tool for randomized trials. This systematic review is registered in PROSPERO (CRD42022306598) and was prepared based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Results: A total of five randomized controlled trials (RCTs) with 33,959 participants were included for final analysis. These studies showed that rivaroxaban with aspirin was more effective than the standard therapy of aspirin alone in the prevention of secondary cardiovascular events (major adverse cardiovascular events (MACEs) and/or major adverse limb events (MALEs), but the combination increased major bleeding. Conclusion: The combination of rivaroxaban with aspirin is more effective than aspirin alone in the prevention of both MACEs and MALEs in patients with stable CAD and/or PAD. However, the combination treatment is associated with increased of major bleeding. Therefore, the combination of rivaroxaban and aspirin is superior to monotherapy in the management of patients with a high risk of developing MACEs and MALEs.
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Debasu et al. (2022) conducted a systematic review in Stable coronary artery disease (SCAD) and/or peripheral artery disease (PAD) (n=33,959). Rivaroxaban plus aspirin vs. Aspirin alone was evaluated on Secondary cardiovascular events (major adverse cardiovascular events (MACEs) and/or major adverse limb events (MALEs)). Rivaroxaban combined with aspirin was superior to aspirin alone in preventing MACEs and MALEs in patients with stable CAD and/or PAD, although it increased major bleeding.
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