Abstract 4368483: Low Dose Rivaroxaban Plus Aspirin Improves Cardiovascular Outcomes and Reduces Mortality in Coronary Artery Disease

Introduction: Coronary Artery Disease (CAD) is the most common type of heart disease and remains a leading cause of mortality worldwide. An estimated nine million people die from coronary heart disease each year. Dual-pathway inhibition (DPI), combining low-dose rivaroxaban (2.5 mg twice daily) with aspirin, has emerged as a novel strategy to reduce major adverse cardiac events (MACE) in patients with coronary artery disease (CAD). While DPI reduces ischemic events, it may increase bleeding risk. Methodology: This study aims to evaluate the efficacy and safety of DPI compared to aspirin monotherapy in stable CAD patients with or without prior PCI through available clinical studies. The efficacy and safety profile will be analysed in terms of MACE(cardiovascular death, myocardial infarction, stroke), all-cause mortality, and bleeding complications. Results: The COMPASS trial demonstrated that dual pathway inhibition (DPI) using low-dose rivaroxaban in combination with aspirin led to a 24% reduction in major adverse cardiovascular events (MACE) and an 18% decrease in all-cause mortality when compared to aspirin alone. Follow-up studies further confirmed substantial reductions in MACE and myocardial infarction, showing consistent benefits across various patient groups, regardless of their previous PCI status. Although DPI does come with an increased risk of major bleeding, it’s important to note that there was no significant increase in fatal or intracranial hemorrhages. Additionally, real-world registry data reinforced the findings from the trials, indicating lower event rates among patients with diabetes, renal impairment, heart failure, and polyvascular disease. The most noteworthy benefit was found in patients having high ischemic risk but low bleeding risk profiles. Conclusion: Dual-pathway inhibition with low-dose rivaroxaban and aspirin significantly reduces cardiovascular events in patients with CAD and demonstrates a consistent safety profile. These findings support DPI as an effective treatment strategy for secondary prevention in stable atherosclerotic disease.