![]() ![]() A randomized trial of rivaroxaban in addition to aspirin in patients with stable atherosclerotic disease was needed. However, the ATLAS trial has been criticized for missing data leading to uncertainty regarding its results. Furthermore, the ATLAS ACS-2, TIMI 51 trial demonstrated that in patients with recent acute coronary syndrome, low-dose rivaroxaban in addition to background dual-antiplatelet therapy reduced recurrent thrombosis rates without increasing bleeding rates. Whether the newer direct-acting oral anticoagulants (e.g., rivaroxaban), which demonstrate similar antithrombotic efficacy as warfarin but with lower risk of bleeding, may provide a safer means of more effective thrombotic protection is unclear. Previous studies investigating whether therapeutic anticoagulation with warfarin in addition to standard-of-care low-dose aspirin have largely demonstrated modestly improved event rates but with substantially increased risk of bleeding (including intracranial bleeding). This benefit was offset by a 1.2% increased absolute risk in major bleeding.ĭespite effective secondary prevention strategies in patients with established stable atherosclerotic disease, the risk of recurrent events remains in the range of 5-10% per year. In patients with established stable atherosclerotic disease, rivaroxaban plus aspirin resulted in a modest 1.3% absolute risk reduction in cardiovascular death, stroke, or nonfatal MI, with a trend toward improved mortality. In patients with established stable atherosclerotic disease, is rivaroxaban plus aspirin more effective than aspirin alone in reducing cardiovascular death, stroke, or nonfatal MI?
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