Rivaroxaban Monotherapy is Preferable to Combination Therapy with Antiplatelets with Regards to Total Cardiovascular and Bleeding Events in Patients with AF and Stable CAD

In this study conducted across 294 centers, 2,215 patients were randomly assigned to rivaroxaban monotherapy, or therapy with rivaroxaban in combination with aspirin or a P2Y12 inhibitor. All patients were diagnosed with AF with a CHADS2 score greater than one, as well as confirmed CAD without percutaneous coronary intervention (PCI) or coronary artery bypass grafting within 12 months. Primary endpoints were the total number of first and subsequent bleeding and thrombotic events over a 24-month follow-up period. Thrombotic events included ischemic stroke, systemic embolism, myocardial infarction, and unstable angina requiring PCI. The total event rate was 12.2% and 19.2% for the monotherapy and combination therapy groups, respectively. Rivaroxaban monotherapy had a 31% reduction in first events and a 54% reduction in subsequent events. The rivaroxaban and combination-therapy groups had mortality rates of 3.7% and 6.6%, respectively. The mortality rate of bleeding events was higher than that of thrombotic events, regardless of the treatment group. Limitations include open-label study design and minimal patient diversity. The 24-month follow-up period may not fully capture the lifetime risk of events. Bottom line: Rivaroxaban monotherapy as compared to rivaroxaban in combination with an antiplatelet agent for patients with AF and stable CAD is associated with a reduction in both first-time and total number of thrombotic and bleeding events. Citation: Naito R, et al. AFIRE Inv...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: CAD & Atherosclerosis Cardiology In the Literature Source Type: research