2.8.2.5 Prevention of Atherothrombotic events

Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease

Low dose rivaroxaban▼ 2.5mg twice daily (i.e. a quarter of the usual daily anticoagulant dose) plus aspirin 75mg daily is recommended as an option (under specialist guidance) for preventing atherothrombotic events in adults with coronary artery disease or symptomatic peripheral artery disease who are at high risk of ischaemic events. In the COMPASS trial, compared with aspirin alone, low dose rivaroxaban plus aspirin reduced the risk of having an ischaemic stroke, myocardial infarction or dying from cardiovascular disease by 24% (4.1% v 5.4%). All cause death was reduced by 18% (3.4% v 4.1%). Major bleeding was increased by 70% (3.1% v 1.9%) but there was no significant increase in fatal or intracranial bleeding. Clinicians should carefully assess if bleeding risk outweighs potential benefit in individual patients.

Refer to NICE TA607