Rivaroxaban to Reduce the Risk of Major Cardiovascular Events in Patients with Chronic Coronary Artery Disease or Peripheral Artery Disease: A Narrative Review.

Abstract

Coronary Artery Disease (CAD) and Peripheral Artery Disease (PAD) are leading causes of death and illness worldwide. These conditions greatly impact the quality of life and increase the risk of serious cardiovascular and limb events (MACE and MALE). Even with advances in medical treatments, patients with chronic CAD and PAD still face a high risk of thrombotic events. Traditional anticoagulant therapies, such as warfarin combined with aspirin, have not effectively reduced cardiovascular events and often lead to major bleeding. Therefore, rivaroxaban, an oral factor Xa inhibitor, has emerged as a promising therapeutic agent. The COMPASS trial found that combining low-dose rivaroxaban with aspirin significantly reduces MACE and MALE in chronic CAD and PAD patients, though it also increases the risk of major bleeding. Additional studies, including COMPASS, LTOLE and VOYAGER PAD, have confirmed these results, demonstrating rivaroxaban's effectiveness and safety across different patient groups. It is important to note that the populations studied in these trials differ significantly, particularly regarding the heart failure population. Some patients, such as those with recent worsening chronic heart failure, do not benefit from rivaroxaban. Specifically, the COMMANDER HF trial found that in patients with chronic heart failure, reduced ejection fraction, and coronary artery disease who were not in atrial fibrillation, low-dose rivaroxaban did not significantly reduce the risk of death, myocardial infarction, or stroke compared to placebo. These distinct population characteristics highlight the importance of considering specific patient factors when interpreting the efficacy of rivaroxaban. Cost-effectiveness analyses from various healthcare systems show that rivaroxaban, especially when used with aspirin, is a cost-effective treatment for CAD and PAD patients. This review explores rivaroxaban's role in reducing MACE and MALE in CAD and PAD patients, discussing its pharmacology, uses, effectiveness, safety, and cost-efficiency. It also reviews recent research and recommendations for specific patient characteristics, offering a comprehensive overview and future perspectives on its role in managing cardiovascular diseasess.