Key result
Rivaroxaban plus low-dose aspirin reduces major adverse events ~24% in chronic atherosclerotic vascular disease.
Why the study?
To examine the rationale for targeting coagulation factor Xa in atherosclerosis, review the trials leading to rivaroxaban and aspirin approval in chronic CAD or PAD, and discuss unresolved implementation challenges.
Does the combination of rivaroxaban and aspirin reduce major adverse events in patients with chronic coronary artery disease or peripheral artery disease?
Does the combination of rivaroxaban and aspirin reduce major adverse events in patients with chronic coronary artery disease or peripheral artery disease?
The combination of low-dose rivaroxaban and aspirin provides a net clinical benefit by reducing major adverse events and mortality in patients with chronic coronary or peripheral artery disease, despite an initial increase in major bleeding.
May support dual pathway inhibition in chronic atherosclerotic disease; leaves open optimal selection amid low-certainty evidence.
In the COMPASS trial, the combination of rivaroxaban 2.5 mg twice daily and low-dose aspirin 75-100 mg daily produced a net clinical benefit of 20% in patients with chronic atherosclerotic vascular disease because it reduced major adverse events by 24% and overall mortality by 18% despite an initial increase in major bleeding. In this paper, we examine the rationale for targeting coagulation factor Xa in patients with atherosclerosis, summarize the pharmacology of the 2.5-mg dose, review the trials that led to the approval of the combination of rivaroxaban and aspirin for the long-term management of patients with chronic coronary artery disease or peripheral artery disease and discuss who would benefit the most. We also address the unresolved issues and challenges in the implementation of this therapy.
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Wheeler et al. (2020) conducted a review in Chronic coronary artery disease or peripheral artery disease. Rivaroxaban and aspirin was evaluated. The combination of rivaroxaban 2.5 mg twice daily and low-dose aspirin reduces major adverse events by 24% and overall mortality by 18% in patients with chronic atherosclerotic vascular disease.
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