Rivaroxaban-balances bleeding risk in chronic coronary syndrome

Globally, the prevalence of chronic coronary syndrome (CCS) increases with age. In India, there is a rapidly growing burden of coronary artery disease (CAD), which has become the leading cause of morbidity and mortality. JAPI reports a review article, about Rivaroxaban a new drug that is effective in managing bleeding risk and ischemic events in Chronic coronary syndrome.

Despite recommended medical therapy, patients with chronic coronary syndrome are still at risk of ischemic events. Currently, dual antiplatelet therapy (DAPT) is recommended in the form of aspirin and low dose rivaroxaban in patients with stable coronary artery disease and/or peripheral artery disease (PAD).

Rivaroxaban has shown a low risk of drug-drug interaction, and it does not require regular monitoring for coagulation if given at fixed doses; owing to its predictable pharmacokinetics and pharmacodynamics properties. When the tablet is orally taken, it is quickly absorbed, and the maximum plasma concentration is achieved in 2–4 hours.

A low dose of rivaroxaban in combination with aspirin is a promising approach; however, for patients who might benefit the most, it still remains a challenge. Clinical trial data on this new drug was certainly very encouraging, with evidence from the COMPASS trial which was previously discussed.

To review it, the subgroups of COMPASS trials suggested that the addition of rivaroxaban to aspirin was associated with a significantly lower risk of ischemic events, mortality, and tolerable bleeding profile in patients with chronic coronary syndrome and high-risk factors.

Thus, this combination is cost-effective and generally well tolerated in patients with coronary artery disease and peripheral artery disease, as well as patients with chronic coronary syndrome and multimorbidity or high-risk populations.

Reference: Adik-Pathak L, Shirodkar S, Gupta A. Rivaroxaban, a New Molecule with Potential to Balance Bleeding Risk and Ischemic Events in Patients with Chronic Coronary Syndrome. J Assoc Physicians India 2022;70(8):84–88.