Authors
Gibson CM, Chakrabarti AK, Mega J, et al.
Title
Reduction of stent thrombosis in patients with acute coronary syndromes treated with rivaroxaban in ATLAS-ACS 2 TIMI 51.
References
J Am Coll Cardiol. 2013 Jul 23;62(4):286-90
Background
Dual antiplatelet therapy (DAPT) has been the mainstay of efforts to prevent stent thrombosis. Because thrombin is a potent stimulant of platelet activation, we hypothesized that inhibition of thrombin generation via factor Xa inhibition may further reduce the risk of stent thrombosis.
Purpose
To determine if rivaroxaban is associated with a reduction in stent thrombosis among patients with acute coronary syndromes (ACS) in Addition to Standard Therapy.
Design
Prospective randomized placebo-controlled trial 15526 patients with acute coronary syndromes treated with angioplasty and coronary stent implantation Endpoint: Stent thrombosis. Composite of death from cardiovascular causes, MI, stroke
Exclusion Criteria
Contraindications against treatment with Rivaroxaban.
Follow-Up
Mean 13 months, up to 31 months
Treatment Regimen
Placebo versus rivaroxaban 2.5mg BID versus rivaroxaban 5mg BID
Results
Primary Endpoints: Both doses of rivaroxaban combined reduce definite/ probable stent thrombosis 9 (HR 0.65, CI 0.46-0.91) Among patients receiving ASA and a thienopyridine, there was a benefit of rivaroxaban during DAPT treatment before discontinuation of the thienopyridine (HR 0.68, CI 0.50-0.92) Mortality reduction in the group with 2.5mg rivaroxaban BID but not 5mg BID (HR 0.56, CI 0.35-0.89) Secondary Endpoints: Reduction of stent thrombosis consistent over a number of subgroups Bleeding endpoints not reported in this manuscript
Summary
Rivaroxaban in addition to DAPT reduced stent thrombosis, and at a dose of 2.5mg BID reduced mortality in this study in patients with ACS. Bleeding endpoints not reported in this manuscript.
Implications
Implications from this manuscript are not clear: Although it is evident that the addition of Rivaroxaban to DAPT leads to a reduction of stent thrombosis, this is likely associated with an increased bleeding risk. The bleeding risk was not reported in this study.
Related Figures
None.