Key result
Dual pathway inhibition with low-dose rivaroxaban and antiplatelet therapy reduces ischemic events and mortality after acute coronary syndromes but increases major bleeding, limiting its routine clinical use.
Why the study?
Does dual pathway inhibition with low-dose rivaroxaban improve cardiovascular outcomes in patients after acute coronary syndromes?
Does dual pathway inhibition with low-dose rivaroxaban improve cardiovascular outcomes in patients after acute coronary syndromes?
This review evaluates the pros and cons of dual pathway inhibition with low-dose rivaroxaban for secondary prevention after acute coronary syndromes, balancing ischemic benefits against bleeding risks.
May support low-dose rivaroxaban post-ACS; leaves open bleeding risk and optimal patient selection.
The optimal anti-thrombotic therapy for secondary prevention after an acute coronary syndrome is still a matter of debate. While current guidelines recommend dual anti-platelet therapy with aspirin and a P2Y12 inhibitor over 12 months especially in patients with stent implantation, the value of prolonged anticoagulation is still controversial. In the ATLAS-TIMI 52 trial, a low-dose direct factor Xa inhibition with rivaroxaban compared with placebo reduced the combined primary endpoint of cardiovascular mortality, myocardial infraction and stroke with an increase in major bleeding complications. This article discusses the value and problems of adding low-dose rivaroxaban to anti-platelet therapy as secondary prevention measure after an acute myocardial infarction. It will describe the pros and cons of intensified anti-platelet therapy versus dual pathway inhibition and give recommendations for different patient groups in clinical practice.
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Zeymer et al. (2018) conducted a review in Acute Coronary Syndromes. Dual pathway inhibition (low-dose rivaroxaban plus antiplatelet therapy) vs. Standard antiplatelet therapy was evaluated. Dual pathway inhibition with low-dose rivaroxaban and antiplatelet therapy reduces ischemic events and mortality after acute coronary syndromes but increases major bleeding, limiting its routine clinical use.
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