Effectiveness of low-dose rivaroxaban in preventing recurrent major adverse cardiovascular events in coronary artery disease: a systematic review and meta-analysis of randomized controlled trials.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2024-11-01 Epub Date: 2024-09-25 DOI:10.1097/MCA.0000000000001381

Hussam Al Hennawi, Muhammad Khuzzaim Khan, Faisal Rasheed, Sushma Rathi, Mirha Ali, Abraish Ali, Zoha Asghar, Khadija Pasha, Muhammad Talal Ashraf, Bruce Klugherz

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引用次数: 0

Abstract

Introduction: Despite advancements in coronary artery disease (CAD) management, major adverse cardiovascular events persist. Vitamin K antagonists and direct oral anticoagulants present bleeding risks. Low-dose rivaroxaban (2.5 mg) is approved by the European Society of Cardiology and the US Food and Drug Administration for CAD. The survival advantage and risk-benefit profile of combining low-dose rivaroxaban with aspirin for CAD patients remain uncertain. This meta-analysis aims to compare the efficacy of low-dose rivaroxaban plus aspirin versus aspirin monotherapy in CAD patients.

Methods: We systematically searched databases for randomized controlled trials exploring low-dose rivaroxaban with aspirin in CAD patients. Of the 6220 studies screened, five met the inclusion criteria. Primary outcomes included myocardial infarction, stroke, major bleeding events, and all-cause mortality. The analysis employed a fixed-effects model, calculating hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Five randomized controlled trials involving 41,351 participants were included. Rivaroxaban (2.5 mg) significantly reduced all-cause mortality (HR, 0.88; 95% CI, 0.81-0.95; P = 0.002), myocardial infarction (HR, 0.81; 95% CI, 0.70-0.94; P = 0.006), and stroke (HR, 0.61; 95% CI, 0.49-0.76; P < 0.00001) compared to aspirin alone. However, it increased major bleeding risk (HR, 1.66; 95% CI, 1.40-1.97; P < 0.01). Meta-regression revealed no dose-dependent impact on all-cause mortality.

Conclusion: Low-dose rivaroxaban demonstrates survival benefits and reduces myocardial infarction and stroke risks in CAD patients, albeit with an increased risk of major bleeding. Consideration of patient bleeding risk is crucial when adding rivaroxaban to antiplatelet therapy. Further research is warranted to compare its effectiveness and safety with dual antiplatelet therapy or P2Y12 inhibitors.

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小剂量利伐沙班预防冠心病复发主要不良心血管事件的效果：随机对照试验的系统回顾和荟萃分析。

导言：尽管冠状动脉疾病（CAD）治疗取得了进步，但重大不良心血管事件依然存在。维生素 K 拮抗剂和直接口服抗凝剂存在出血风险。低剂量利伐沙班（2.5 毫克）已获欧洲心脏病学会和美国食品药品管理局批准用于治疗冠心病。将低剂量利伐沙班与阿司匹林联合用于治疗心血管疾病患者的生存优势和风险收益情况仍不确定。本荟萃分析旨在比较低剂量利伐沙班联合阿司匹林与单用阿司匹林治疗 CAD 患者的疗效：我们在数据库中系统检索了探讨低剂量利伐沙班联合阿司匹林治疗 CAD 患者的随机对照试验。在筛选出的 6220 项研究中，有 5 项符合纳入标准。主要结果包括心肌梗死、中风、大出血事件和全因死亡率。分析采用固定效应模型，计算危险比（HRs）和 95% 置信区间（CIs）：结果：共纳入了五项随机对照试验，涉及 41351 名参与者。利伐沙班（2.5 毫克）能显著降低全因死亡率（HR，0.88；95% CI，0.81-0.95；P = 0.002）、心肌梗死（HR，0.81；95% CI，0.70-0.94；P = 0.006）和中风（HR，0.61；95% CI，0.49-0.76；P 结论：利伐沙班（2.5 毫克）能显著降低全因死亡率（HR，0.88；95% CI，0.81-0.95；P = 0.002）和中风（HR，0.81；95% CI，0.70-0.94；P = 0.006）：低剂量利伐沙班可提高 CAD 患者的生存率，降低心肌梗死和脑卒中风险，但会增加大出血风险。在抗血小板疗法中加入利伐沙班时，考虑患者的出血风险至关重要。有必要开展进一步研究，比较利伐沙班与双重抗血小板疗法或 P2Y12 抑制剂的有效性和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.