Rivaroxaban to reduce the risk of major cardiovascular events in patients with chronic coronary artery disease or peripheral artery disease: a narrative review.

Abstract

Background: Coronary Artery Disease (CAD) and Peripheral Artery Disease (PAD) are leading causes of morbidity and mortality. Despite medical advancements, patients remain at high risk for major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Traditional anticoagulation strategies have shown limited efficacy. Rivaroxaban, an oral factor Xa inhibitor, has emerged as a potential alternative.

Objectives: This review examines the role of rivaroxaban in reducing MACE and MALE in CAD and PAD patients, focusing on its pharmacology, efficacy, safety, and cost-effectiveness.

Methods: A literature search was conducted in PubMed, Embase, and Scopus for studies on rivaroxaban's use in CAD and PAD.

Results: The COMPASS trial demonstrated that rivaroxaban (2.5 mg twice daily) plus aspirin significantly reduced MACE and MALE but increased major bleeding. The COMPASS-LTOLE and VOYAGER PAD trials confirmed these findings. However, the COMMANDER HF trial found no benefit in heart failure patients without atrial fibrillation. Cost-effectiveness studies support rivaroxaban as a viable treatment strategy.

Conclusion: Rivaroxaban plus aspirin effectively reduces thrombotic events in high-risk CAD and PAD patients. Despite an increased bleeding risk, its benefits outweigh the risks in selected populations. Future studies should explore personalized treatment approaches and long-term outcomes.