Key result
The combination of rivaroxaban and aspirin resulted in a 24% reduction in cardiovascular death, stroke, or myocardial infarction compared to aspirin alone.
Why the study?
Does the combination of low-dose rivaroxaban and aspirin reduce cardiovascular events in patients with stable coronary artery disease or peripheral artery disease?
RCT (n=27,395)
Does the combination of low-dose rivaroxaban and aspirin reduce cardiovascular events in patients with stable coronary artery disease or peripheral artery disease?
Effect estimate: 24% reduction
The addition of low-dose rivaroxaban to aspirin substantially reduces cardiovascular morbidity and mortality in patients with stable coronary or peripheral artery disease.
May support dual pathway inhibition in stable CAD/PAD; extends synthesized evidence but leaves practice change open.
The cardiovascular outcomes for people using anticoagulation strategies (NCT01776424) trial randomized 27,395 patients with stable coronary artery disease or peripheral artery disease (PAD) to receive rivaroxaban 5 mg twice-daily alone, the combination of rivaroxaban 2.5 mg twice-daily and aspirin 100 mg daily, or aspirin 100 mg daily alone. The combination arm resulted in a 24% reduction in the primary end point of cardiovascular death, stroke or myocardial infarction, and an 18% reduction in mortality. Rivaroxaban alone did not produce any additional benefit compared with aspirin. The combination therapy also reduced major adverse limb events, including amputation, in patients with PAD. Based on these results, the addition of rivaroxaban to aspirin is expected to substantially reduce morbidity and mortality in patients with stable coronary or PAD.
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Bhagirath et al. (2018) conducted an RCT in stable coronary artery disease or peripheral artery disease (n=27,395). Rivaroxaban plus aspirin vs. aspirin 100 mg daily alone or rivaroxaban 5 mg twice-daily alone was evaluated on cardiovascular death, stroke or myocardial infarction (24% reduction). The combination of rivaroxaban and aspirin resulted in a 24% reduction in cardiovascular death, stroke, or myocardial infarction compared to aspirin alone.
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