Key result
The addition of rivaroxaban 2.5 mg twice daily to aspirin significantly reduced the risk of major atherosclerotic outcomes and mortality in patients with atherosclerotic vascular disease.
Why the study?
Using only antiplatelet therapy for secondary prevention leaves a substantial risk of recurrent cardiovascular complications and mortality.
Does the addition of rivaroxaban 2.5 mg twice daily to aspirin reduce the risk of major atherosclerotic outcomes in patients with coronary heart disease and/or peripheral artery disease?
Does the addition of rivaroxaban 2.5 mg twice daily to aspirin reduce the risk of major atherosclerotic outcomes in patients with coronary heart disease and/or peripheral artery disease?
Adding low-dose rivaroxaban (2.5 mg twice daily) to aspirin provides significant vascular protection and reduces mortality in patients with atherosclerotic vascular disease, despite an increased risk of non-fatal major bleeding.
Answers are grounded in this paper and cite their sources.
Supports dual pathway inhibition in atherosclerotic disease; leaves open need for randomized confirmation before practice change.
Introduction: The current approach of using only antiplatelet therapy for secondary prevention leaves a substantial risk of recurrent cardiovascular complications and mortality.Areas covered: In this manuscript, the role of coagulation in atherothrombosis is reviewed, as well as the impact of vascular doses of rivaroxaban on major cardiovascular outcomes and major adverse limb events.Expert opinion: In COMPASS, among patients with coronary heart disease and/or peripheral artery disease, compared to aspirin, the addition of rivaroxaban 2.5 mg twice daily to aspirin, significantly reduced the risk of major atherosclerotic outcomes, cardiovascular death and death for any cause, with a significant increase in the risk of major bleeding, but not fatal or intracranial bleedings. Preclinical data strongly suggest that rivaroxaban exerts vascular protection through different mechanisms, including improvement of endothelial functionality and fibrinolytic activity at endothelium, anti-inflammatory properties, and platelet-dependent thrombin generation. All these data indicate that among patients with atherosclerotic vascular disease, the addition of rivaroxaban 2.5 mg may provide further vascular protection.
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Sanmartı́n et al. (2019) conducted a review in Atherosclerotic vascular disease. Rivaroxaban vs. Aspirin was evaluated on Major atherosclerotic outcomes, cardiovascular death and death for any cause. The addition of rivaroxaban 2.5 mg twice daily to aspirin significantly reduced the risk of major atherosclerotic outcomes and mortality in patients with atherosclerotic vascular disease.
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