Efficacy and safety of low dose rivaroxaban in patients with coronary heart disease: a systematic review and meta-analys
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Efficacy and safety of low dose rivaroxaban in patients with coronary heart disease: a systematic review and meta‑analysis Safi U. Khan1 · Muhammad Zia Khan1 · Zain Ul Abideen Asad2 · Shahul Valavoor1 · Muhammad Usman Khan1 · Muhammad Shahzeb Khan3 · Troy Krupica1 · Mohamad Alkhouli4 · Edo Kaluski5
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The mortality effects and risk–benefit profile of low dose rivaroxaban (2.5 mg twice daily) in patients with coronary heart disease are not completely understood. Five randomized controlled trials (26,110 patients) were selected using PubMed and Cochrane library till April 2019. The background antiplatelet therapy was aspirin in 3 trials, P2Y12 inhibitor in 1 trial, and in 1 trial 65% patients received aspirin and 35% were on dual antiplatelet therapy (DAPT). The outcomes of interest were cardiovascular mortality, all-cause mortality, myocardial infarction (MI), stroke and major bleeding events. Random effects hazard ratios (HR) with 95% confidence intervals (CI) were calculated. Low dose rivaroxaban did not reduce the risk of cardiovascular mortality (HR 0.90, 95% CI 0.73–1.11, P = 0.34) or all-cause mortality (HR 0.91, 95% CI 0.74–1.12, P = 0.38) compared with control. However, low dose rivaroxaban was associated with reduction in MI (HR 0.85, 95% CI 0.73–0.99, P = 0.04), and stroke (HR 0.59, 95%CI 0.48–0.73, P 75% being consistent with a high degree of heterogeneity [16]. Publication bias was not assessed due to small number of studies (
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