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Rivaroxaban Balances Bleeding Risk in Patients with Chronic Coronary Syndrome - JAPI Report - Video

Published On 2022-08-13T10:00:00+05:30  |  Updated On 13 Aug 2022 12:57 PM IST
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Overview

Rivaroxaban has a low risk of drug interactions, 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. This has been reported in a review published in the Journal of the Association of Physician of India (JAPI).

The trial that comes into the picture is the COMPASS trial, which is a large trial that included more than 27,000 patients with stable coronary artery disease or peripheral artery disease. Participants were randomly assigned to receive rivaroxaban (2.5 mg twice daily) plus acetylsalicylic acid (once daily), rivaroxaban (5 mg twice daily) alone, or acetylsalicylic acid (once daily) alone.

Patients treated with rivaroxaban in combination with acetylsalicylic acid experienced significant benefits compared with acetylsalicylic acid alone. After a mean follow-up of 23 months, low-dose rivaroxaban in combination with acetylsalicylic acid was significantly associated with lower rates of a composite of cardiovascular death, stroke, or myocardial infarction than acetylsalicylic acid.

Even though the bleeding risk was increased in the combination arm without a significant increase in fatal or critical organ bleeding, combination therapy resulted in lower mortality and ischemic events compared to acetylsalicylic acid monotherapy.

Consistent benefits of rivaroxaban added to aspirin therapy were reported in patients with peripheral artery disease undergoing lower-extremity revascularization. A total of 15,526 patients with a recent acute coronary syndrome were included. In this trial, rivaroxaban was found to be associated with a reduced risk of the composite endpoint of death from cardiovascular causes, MI, or stroke. Rivaroxaban increased the risk of major bleeding and intracranial hemorrhage but not the risk of fatal bleeding.

In conclusion, clinical trial data on this new drug was certainly very encouraging, with evidence from the COMPASS trial and pre-specified subgroups of the COMPASS trials suggesting 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.

This combination is cost-effective and generally well tolerated in patients with coronary artery disease and/or peripheral artery disease as well as patients with chronic coronary syndrome and multimorbidity or high-risk populations. Therefore, on the basis of comorbidities and other risk factors, patients should be individually evaluated for polypharmacy approach and cost while considering the addition of rivaroxaban to the ongoing therapy.

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

Speakers

Dr. Nandita Mohan

Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751
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