Coronary disease: Long-term Antithrombotic therapy: Combining antiplatelet drugs with oral anticoagulants (factor Xa inhibitors)
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2011 Aug 25;365(8):699-708. [Epub 2011 Jul 24] Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
anticoagulants, oral factor Xa inhibitors, apixaban, 5 mg twice daily
As Treatment, Chronic
Is worse Than
placebo
To improve results at 8 months: it increase in major bleeding events (1.3% apixaban VS 0.5% placebo) and did not reduced cardiovascular events (7.5% apixaban VS 7.9% placebo)
N Engl J Med. 2012 Jan 5;366(1):9-19. Epub 2011 Nov 13 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban, 2.5 or 5 mg twice daily, in addition to double antiplatelet treatment
As Treatment, Chronic
Is better Than
placebo
To reduce at 13 months cardiovascular events (cardiovascular death, myocardial infartion , stroke): 8.9% rivaroxaban VS 10.7% placebo. However, it increases major bleedings: 2.1% rivaroxaban VS 0.6% placebo
N Engl J Med. 2016 Dec 22;375(25):2423-2434 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
low-dose rivaroxaban (15 mg /d) plus an P2Y12 inhibitor antiplatelet for 12 months OR very-low-dose rivaroxaban (2.5 mg twice daily) plus dual antiplatelet for 1, 6, or 12 months
As Treatment, Chronic
Is better Than
dose-adjusted vitamin K antagonist plus dual antiplatelet for 1, 6, or 12 months
To reduce clinically significant bleeding (17% rivaroxaban 15 + 1 antiplatelet, 18% rivaroxaban 2.5 + 2 antiplatelets, and 26.7% antivitamin K + 2 antiplatelets) while having similar rates of cardiovascular events (6.5%, 5.6% and 6% respectively)
N Engl J Med. 2017 10 05;377(14):1319-1330 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily)
As Treatment, Chronic
Is better Than
rivaroxaban (5 mg twice daily) alone, or aspirin (100 mg once daily) alone
To reduce cardiovascular events (death, stroke or MI): 4.1% riva+aspirine VS 5.4% aspirine. But increased major bleeding: 3.1% VS 1.9%. Riva 5 mg/d alone did not better than aspirin and had more bleeding.