Rivaroxaban: A Review for Secondary CV Prevention in CAD and PAD
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ADIS DRUG EVALUATION
Rivaroxaban: A Review for Secondary CV Prevention in CAD and PAD Lesley J. Scott1
© Springer Nature Switzerland AG 2020
Abstract Secondary cardiovascular (CV) prevention in patients with vascular disease [e.g. coronary (CAD) and peripheral (PAD) artery disease] is crucial and typically involves antiplatelet therapy with aspirin; however, managing residual ischaemic and bleeding risks in CV disease (CVD) remains a challenge. Combining the oral anticoagulant rivaroxaban ( Xarelto®) with aspirin targets both the platelet and thrombotic processes of atherosclerosis, a common pathophysiological process associated with CVD. In the global COMPASS trial (n > 27,000), rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily (vs aspirin alone) significantly reduced the risk of the primary composite major adverse CV event (MACE) outcome (i.e. myocardial infarction, stroke or CV death) in adults with stable CAD and/or PAD and, in those with PAD, significantly reduced the risk of the composite major adverse limb event (MALE) outcome. Rivaroxaban + aspirin treatment was generally well tolerated; however, the risk of the composite major bleeding outcome, but not intracranial or fatal bleeding, was significantly higher with rivaroxaban + aspirin than aspirin. The increased risk for the composite major bleeding outcome did not negate the composite net clinical benefits of rivaroxaban + aspirin for secondary CV prevention, with rivaroxaban + aspirin especially beneficial in those with a greater CV risk at baseline. Ongoing clinical experience is required to fully define the role of rivaroxaban + aspirin in secondary CV prevention. In the meantime, dual therapy with rivaroxaban + aspirin is an important emerging option for secondary CV prevention of atherothrombotic events in adults with CAD or symptomatic PAD who are at high risk of ischaemic events.
Rivaroxaban: clinical considerations for secondary CV prevention in CAD and PAD
Enhanced material for this Adis Drug Evaluation can be found at https://doi.org/10.6084/m9.figshare.12580745. The manuscript was reviewed by: S. Frol, Department of Vascular Neurology, University Clinical Centre Ljubljana, Ljubljana, Slovenia; R. B. Grobben, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands; D. Morrone, Department of Cardiology Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy; A. J. Nelson, Department of Cardiology, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, Adelaide, South Australia, Australia. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40265-020-01397-7) contains supplementary material, which is available to authorized users. * Lesley J. Scott [email protected] 1
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Oral low-dose dual therapy with an anticoagulant (rivaroxaban) and an antiplatelet drug (aspirin) Versus aspirin alone, dual therapy si
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