Key result
Aspirin combined with very low-dose rivaroxaban reduced recurrent ischemic events at the cost of increased bleeding in patients with stable atherosclerotic disease.
Why the study?
Cardiovascular disease remains the leading cause of morbidity and mortality, requiring effective secondary prevention strategies to reduce recurrent cardiovascular events in patients with stable atherosclerotic disease.
Does the combination of very low-dose rivaroxaban and aspirin reduce recurrent ischemic events in patients with stable atherosclerotic disease?
Does the combination of very low-dose rivaroxaban and aspirin reduce recurrent ischemic events in patients with stable atherosclerotic disease?
The dual pathway concept combining aspirin and very low-dose rivaroxaban is an effective strategy to reduce recurrent ischemic events in high-risk patients with stable atherosclerotic disease, though it increases bleeding risk.
May benefit selected high-risk patients despite bleeding; leaves open optimal selection and mitigation strategies.
INTRODUCTION: Cardiovascular disease is the leading cause of morbidity and mortality in adults in western nations. In the last decades, tremendous research has been conducted in the field of secondary prevention in order to reduce recurrent cardiovascular events. This review summarizes the novel dual pathway concept of aspirin and very low-dose rivaroxaban, from mechanisms to clinical practice. AREAS COVERED: The COMPASS trial demonstrated that in patients with stable atherosclerotic disease, very low-dose rivaroxaban, a direct factor Xa inhibitor, when combined with aspirin, reduced the rate of recurrent ischemic events, at the cost of increased bleeding. This effect was present in patients with ischemic heart disease, as well as in patients with atherosclerosis in other beds, such as in peripheral arterial disease. Sub-studies from the COMPASS trial examined other high-risk populations who might benefit the most from this regimen. EXPERT OPINION: There are currently multiple antiplatelet and anticoagulation treatment regimens for patients with stable atherosclerotic disease. The dual pathway concept is a novel approach that combines both mechanisms. Identifying patients who might benefit the most in terms of ischemic events at the least bleeding events still remains a challenge, yet prescribing this combination to high-risk patients might be the most effective.
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Parascandolo et al. (2020) conducted a review in Stable atherosclerotic disease. Aspirin and very low-dose rivaroxaban was evaluated on Recurrent ischemic events. Aspirin combined with very low-dose rivaroxaban reduced recurrent ischemic events at the cost of increased bleeding in patients with stable atherosclerotic disease.
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