Is a combination of rivaroxaban and aspirin better than either drug alone?

This study investigated the effects of combining rivaroxaban (Xarelto) with aspirin, compared to each drug used alone, in people with stable coronary artery disease. It was determined that the drug combination reduced the risk of stroke, heart attacks, and deaths from cardiovascular causes, more than aspirin alone, but that it increased the risk of major bleeding.

Coronary artery disease (CAD) occurs when blood vessels supplying the heart become narrowed. People with CAD are at risk for complications like heart attacks and strokes. These complications occur when blood clots form. Aspirin and rivaroxaban act in different ways to stop blood clots from forming. Aspirin is the most commonly used drug to prevent complications from CAD. Rivaroxaban is a newer drug that may be effective, but has not been tested in combination with aspirin in people with stable CAD.

24,824 adults with stable CAD participated in this study. They were randomly divided into 3 groups. One group received both rivaroxaban and aspirin (combination group). Another group received rivaroxaban only. The third group received aspirin alone. Participants were followed up every 6 months for an average of 1.95 years for complications of CAD or side effects.

The combination group was 26% less likely to have a heart attack, a stroke, or to die from cardiovascular causes than the aspirin group. The rivaroxaban group had a similar risk to the aspirin group. The combination group was 44% less likely to have a stroke than the aspirin group. However, there was no difference in stroke risk between the aspirin and rivaroxaban groups. The combination group had a 23% lower mortality risk, from any cause, than the aspirin group. However, there was no major difference in mortality risk between the aspirin and rivaroxaban groups.

The combination group was 66% more likely to experience major bleeding than the aspirin group. Additionally, participants in the rivaroxaban group were 51% more likely to have major bleeding than those in the aspirin group. The most common location of major bleeding was in the stomach and intestines. However, bleeding in the head and bleeding resulting in death were not significantly different between the combination group and the aspirin group.

The study concluded that a combination of rivaroxaban and aspirin in people with stable CAD decreased the risk of heart attacks, stroke, and mortality, but increased the risk of major bleeding, when compared to aspirin alone.

80% of the participants were male, and the average age was 68.3 years. Thus, the results may not apply equally to all people with CAD.

This study received funding from the manufacturer of rivaroxaban.

Discuss with your physician which are the best anti-clot forming drugs in your situation.