Key result
Dual pathway inhibition with low-dose rivaroxaban and aspirin reduced the composite of cardiovascular death, stroke, or myocardial infarction by 24% (HR 0.76) compared with aspirin alone.
Why the study?
Patients with vascular diseases remain at high risk of recurrent ischaemic events despite guideline-based therapies, requiring novel therapeutic strategies to address residual risk.
Does dual pathway inhibition with low-dose rivaroxaban and ASA reduce cardiovascular events in patients with chronic CAD and PAD compared to ASA alone?
Does dual pathway inhibition with low-dose rivaroxaban and ASA reduce cardiovascular events in patients with chronic CAD and PAD compared to ASA alone?
Hazard Ratio: 0.76 (95% CI 0.66–0.86)
Absolute Event Rate: 4.1% vs 5.4%
p-value: p=<0.001
Adding low-dose rivaroxaban to aspirin provides a favorable net clinical benefit by significantly reducing ischemic events and mortality in high-risk patients with stable vascular disease, despite an expected increase in non-fatal major bleeding.
Despite available effective guideline-based preventive therapies, patients with vascular diseases remain at high-risk of recurrent ischaemic events. Novel therapeutic strategies are therefore needed in order to further reduce the residual risk that is present in these high-risk patients. The Cardiovascular Outcomes for People using Anticoagulation Strategies trial demonstrated that, in patients with chronic coronary artery disease (CAD) and peripheral artery disease (PAD), a combination of rivaroxaban 2.5 mg/bid (vascular dose) and acetylsalicylic acid (ASA) 100 mg once daily, the so-called dual pathway inhibition (DPI), reduced cardiovascular death, stroke, or myocardial infarction by 24% and mortality by 18%, as compared with ASA-alone. The rationale that can explain the improvement of cardiovascular outcome is that platelet aggregation and fibrin formation are involved in arterial thrombosis and rivaroxaban is able to target both ways and has a synergic effect with ASA. The aim of this review is to discuss the potential mechanisms and added benefits of DPI, in patients with PAD and CAD.
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Leonardo De Luca (2023) conducted a review in Chronic coronary artery disease (CAD) and peripheral artery disease (PAD). Rivaroxaban and acetylsalicylic acid (dual pathway inhibition) vs. Acetylsalicylic acid (ASA) 100 mg once daily was evaluated on Composite of cardiovascular death, stroke, or myocardial infarction (HR 0.76, 95% CI 0.66-0.86, p=<0.001). Dual pathway inhibition with low-dose rivaroxaban and aspirin reduced the composite of cardiovascular death, stroke, or myocardial infarction by 24% (HR 0.76) compared with aspirin alone.
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