2.8.2.4 Acute coronary syndrome

Rivaroxaban in Acute Coronary Syndrome

Refer to NICE TA335 –: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome.

In patients after acute coronary syndrome with elevated cardiac biomarkers, low dose rivaroxaban2.5mg twice daily may be considered as an option, co administered with aspirin 75mg od alone or with aspirin 75mg od plus clopidogrel 75mg od. This should only be undertaken under specialist guidance. Such co-administration may significantly increase bleeding risk and clinicians should carefully assess if bleeding risk outweighs potential benefit in individual patients. Co-administration of rivaroxaban with newer P2Y12 drugs (prasugrel or ticagrelor) is not currently recommended. Treatment discontinuation may be considered at 12 months because experience of treatment beyond this is limited.