Dual antiplatelet therapy to prevent cardiovascular events: is a combination of rivaroxaban and aspirin safe and effective after PCI?

This study investigated the effectiveness of dual antiplatelet therapy (DAPT) with rivaroxaban (Xarelto) and aspirin in patients with a history of percutaneous coronary intervention (PCI). 

They found that DAPT with rivaroxaban and aspirin reduced major adverse cardiac events (MACE) but increased bleeding risk (BR) in these patients. 

Coronary artery disease (CAD) is caused by blockages in the arteries supplying blood to the heart. Reduced blood flow to the heart can lead to major adverse cardiac events (MACE). MACE include heart attacks and stroke. Percutaneous coronary intervention (PCI) is a minimally invasive procedure to treat CAD. It removes blockages and restores blood flow. 

After PCI, blood cells called platelets may collect in the area where the blockage was. This is called platelet aggregation. Anti-platelet therapy (APT) is used to reduce the risk of another blockage after PCI. Aspirin is commonly used in APT. A low dose of aspirin reduces platelet aggregation. Aspirin can be used alone or in with other drugs. This is called dual APT (DAPT). Rivaroxaban is a drug that thins the blood. It is used to reduce the risk of stroke. It could also reduce the risk of clotting after PCI. It is unclear if DAPT with rivaroxaban and aspirin reduces the risk of MACE after PCI compared to aspirin alone. 

This study included 16,560 patients with CAD. Patients were on DAPT or ASP only. 59.6% of patients had prior PCI. The primary outcome was MACE. Bleeding risk (BR) was the main safety outcome.

DAPT with rivaroxaban and aspirin was associated with fewer MACE (24-26% less) than aspirin alone. The effect of DAPT was similar in patients with or without prior PCI. The risk of mortality was 20-27% lower with DAPT. The BR was 58-72% higher with DAPT. 

The authors concluded that DAPT with rivaroxaban and aspirin reduced MACE but increased BR compared to aspirin alone in patients with and without prior PCI.

This was an observational study. Patient treatment was not randomly assigned. Important information on the type of PCI was not available. This could affect the results. A controlled study is needed. 

If you have any concerns regarding CAD management please discuss this with your doctor.