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Debasu Z, Kedir HM, Tadesse TA. Comparison of Aspirin and Rivaroxaban Plus Aspirin in the Management of Stable Coronary Artery Disease or Peripheral Artery Disease: A Systematic Review of Randomized Controlled Trials. Int J Gen Med 2022; 15:7201-7208. [PMID: 36118183 PMCID: PMC9480577 DOI: 10.2147/ijgm.s383485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Low-dose aspirin or clopidogrel, statins, renin–angiotensin system inhibitors, and beta blockers are the cornerstone therapy for cardiovascular prevention in patients with coronary heart disease. Using only single-antiplatelet therapy for secondary prevention in patients with stable coronary artery disease (SCAD) and/or peripheral artery disease (PAD) has a significant risk of recurrent thrombotic complications. Objective This systematic review aimed to compare aspirin alone and its combination with rivaroxaban for secondary cardiovascular prevention in patients with SCAD and/or PAD. Methods The literature search was conducted on PubMed, ClinicalTrials.gov, Cochrane Library, and Google Scholar for articles published from November 2011 to September 2021. An advanced search strategy was used to retrieve relevant studies related to aspirin and/or rivaroxaban use for secondary cardiovascular prevention in patients with SCAD and/or PAD. Records identified from the databases were extracted using a data-abstraction format prepared in Microsoft Excel. Studies’ methodological quality was assessed using the Cochrane risk-of-bias tool for randomized trials. This systematic review is registered in PROSPERO (CRD42022306598) and was prepared based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Results A total of five randomized controlled trials (RCTs) with 33,959 participants were included for final analysis. These studies showed that rivaroxaban with aspirin was more effective than the standard therapy of aspirin alone in the prevention of secondary cardiovascular events (major adverse cardiovascular events (MACEs) and/or major adverse limb events (MALEs), but the combination increased major bleeding. Conclusion The combination of rivaroxaban with aspirin is more effective than aspirin alone in the prevention of both MACEs and MALEs in patients with stable CAD and/or PAD. However, the combination treatment is associated with increased of major bleeding. Therefore, the combination of rivaroxaban and aspirin is superior to monotherapy in the management of patients with a high risk of developing MACEs and MALEs.
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Affiliation(s)
- Zenaw Debasu
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hanan Muzeyin Kedir
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Assefa Tadesse
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Tamrat Assefa Tadesse, Email
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Direct Oral Anticoagulants Versus Vitamin-K Antagonist After PCIs in Patients With AF: A Meta-analysis of Cardiac Ischemic Events. J Cardiovasc Pharmacol 2021; 77:164-169. [PMID: 33351537 DOI: 10.1097/fjc.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Clinical trials have assessed the effect of direct oral antagonists (DOACs) in patients with atrial fibrillation (AF) after percutaneous coronary interventions (PCI). Studies were designed to test the effect on bleeding incidence, but concerns related to safety on ischemic events remain. METHODS We performed a meta-analysis with currently available studies involving DOACs versus Vitamin-K antagonist (VKA) in patients with AF after PCI. The primary endpoint was the incidence of cardiac ischemic events, including myocardial infarction and stent thrombosis. Secondary endpoints were the incidence of stroke, all-cause mortality, and major bleeding. RESULTS Eleven thousand twenty-three patients were included in the analysis: 5510 receiving DOACs and 5513 VKA. A total of 190 cases of myocardial infarction were registered in patients treated with DOACs and 177 in patients on VKA, and no statistical difference was noted [relative risk (RR): 1.07 95% confidence interval (CI) 0.88-1.31]. The incidence of stent thrombosis was very low with no differences between both treatment strategies (RR: 1.14 95% CI 0.76-1.71). The incidence of cardiac ischemic events was the same in patients receiving DOACs or VKA (HR 1.09 95% CI 0.91-1.30). No differences were observed in the incidence of stroke (RR: 0.86 95% CI 0.61-1.23) or mortality (RR: 1.09, 95% CI 0.90-1.31). Treatment with DOACs was associated with 34% reduction in major bleeding (RR: 0.66, 95% CI 0.54-0.81). CONCLUSIONS Treatment with DOACs in patients with AF after a PCI do not increase the risk of cardiac ischemic events, stroke, or death and reduce the incidence of major bleeding by 34% as compared with VKA.
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Nehaj F, Sokol J, Ivankova J, Mokan M, Mokan M, Stasko J. Edoxaban affects TRAP-dependent platelet aggregation. J Thromb Thrombolysis 2020; 49:578-583. [PMID: 32221807 DOI: 10.1007/s11239-020-02093-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Bloemen S, Zwaveling S, Mullier F, Douxfils J. Concomitant assessment of rivaroxaban concentration and its impact on thrombin generation. Thromb Res 2019; 184:8-15. [PMID: 31677449 DOI: 10.1016/j.thromres.2019.09.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reliable assays to measure direct oral anticoagulant (DOAC) levels and their activity in critical situations are needed. Drug levels alone are not representative of the effect of DOACs on an individual's coagulation. We developed a technique that provides direct assessment of the global effect of rivaroxaban on the individual's coagulation in addition to plasma concentrations. METHODS DOAC concentrations were determined in fifty patients using rivaroxaban, with the new assay, Xross-CAT. The effect of rivaroxaban on coagulation (activity) was measured with thrombin generation (TG) in platelet poor plasma using 5 pM tissue factor on the same device. The levels were validated with the Biophen DiXal assay. The prothrombin time (PT) and dilute Russell viper venom time (dRVVT) were performed to estimate the effect on coagulation. RESULTS The variability of Xross-CAT was below 12%. Xross-CAT correlates well with Biophen DiXaI (rs = 0.885). The bias, determined by Bland-Altman analysis, was 4.9% and the Passing-Bablok equation was y = 1.1x - 2.1. The correlation of plasma levels with TG was moderate (ETP rs = -0.548; Peak rs = -0.559), as for the PT (rs = 0.739) and the dRVVT (rs = 0.692). CONCLUSIONS Xross-CAT shows a good correlation with Biophen DiXaI that was previously confirmed to accurately assess rivaroxaban levels. Bleeding and thrombotic complications are not necessarily associated with drug levels and could be influenced by concomitant risk factors. The main benefit of Xross-CAT is that it can be performed simultaneously with thrombin generation, providing an overview of the global anticoagulation status of a patient in relation to circulating DOAC levels.
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Affiliation(s)
- Saartje Bloemen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Suzanne Zwaveling
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - François Mullier
- Université catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center, NARILIS, Yvoir, Belgium
| | - Jonathan Douxfils
- University of Namur, Department of Pharmacy, Namur Research Institute for Life Sciences, Namur Thrombosis and Hemostasis Center, Namur, Belgium; QUALIblood s.a., Namur, Belgium
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Sanmartín M, Bellmunt S, Cosín-Sales J, García-Moll X, Riera-Mestre A, Almendro-Delia M, Hernández JL, Lozano F, Mazón P, Suarez Fernández C. Role of rivaroxaban in the prevention of atherosclerotic events. Expert Rev Clin Pharmacol 2019; 12:771-780. [DOI: 10.1080/17512433.2019.1637732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Sergi Bellmunt
- Vascular Surgery Department, Hospital General Vall d´Hebron, Barcelona, Spain
| | - Juan Cosín-Sales
- Cardiology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Antoni Riera-Mestre
- Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - José Luis Hernández
- Internal Medicine Department, Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Francisco Lozano
- Department of Surgery, Hospital Clinico de Salamanca, Salamanca, Spain
| | - Pilar Mazón
- Cardiology Department, Hospital Clinico Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, Spain
| | - Carmen Suarez Fernández
- Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Fontana P, Alberio L, Angelillo-Scherrer A, Asmis LM, Korte W, Mendez A, Schmid P, Stricker H, Studt JD, Tsakiris DA, Wuillemin WA, Nagler M. Impact of rivaroxaban on point-of-care assays. Thromb Res 2017; 153:65-70. [DOI: 10.1016/j.thromres.2017.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/11/2017] [Accepted: 03/19/2017] [Indexed: 12/25/2022]
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The role of the new oral anticoagulants in the treatment of coronary disease. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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del Portillo H, Badimón JJ, Cabrales JR, Echeverri D. Papel de los nuevos anticoagulantes orales en el tratamiento de la enfermedad coronaria. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bouée S, Emery C, Samson A, Gourmelen J, Bailly C, Cotté FE. Incidence of venous thromboembolism in France: a retrospective analysis of a national insurance claims database. Thromb J 2016; 14:4. [PMID: 26900350 PMCID: PMC4761165 DOI: 10.1186/s12959-016-0078-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/16/2015] [Indexed: 01/28/2023] Open
Abstract
Background Data estimating the annual incidence of venous thromboembolism (VTE) in France, taking into account both hospital and community settings, are very lacking. This study aimed to estimate the annual incidence of VTE (pulmonary embolism (PE) and deep vein thrombosis (DVT)) in France in 2011 in “real world” population. Methods This was a longitudinal insurance claims study of the incidence of VTE in France over 2 years (2010 and 2011). The data analysis was performed using the EGB (Echantillon Généraliste des Bénéficiaires) database, a randomly selected sample of the French national insurance database (CNAMTS) which covers 77 % of the population. All adult patients experiencing a VTE event during the study period were analysed. Recurrence rate of VTE and all-cause mortality rate were also estimated over a 12-month follow-up period. Results The estimated annual incidence of VTE in France was 184.0 per 100 000 subjects, corresponding to a total of 119 670 events countrywide. The estimated incidence of DVT and PE were respectively 119.8 and 64.2 per 100 000 subjects. Annual recurrence of VTE was reported in 5.5 % (n = 99) patients, with a significantly higher recurrence rate in patients with PE than those with DVT (p = 0.02). Overall, 6.2 % (n = 112) of patients had died over the 12-month follow-up (respectively 10.2 and 7.7 % of patients with DVT and PE). Discussion To our knowledge, this analysis is the first to estimate the annual incidence of VTE in France using exhaustive data from the EGB database. This has allowed the incidence of DVT in the community to be documented, which to date has not been characterised. Previous studies in France have been limited to the hospital setting and have yielded incidence rates comparable to ours. Conclusions This analysis is the first to estimate the annual incidence of VTE in France using exhaustive data from the EGB database. This study showed that the incidence and the burden of the disease remains elevated.
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Affiliation(s)
- Stéphane Bouée
- Cemka, 43 bd du Maréchal Joffre, 92340 Bourg-la-Reine, France
| | - Corinne Emery
- Cemka, 43 bd du Maréchal Joffre, 92340 Bourg-la-Reine, France
| | - Adeline Samson
- Paris-Dauphine University, Paris, France ; Bristol-Myers Squibb, Rueil-Malmaison, France
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Hara T, Fukuda D, Tanaka K, Higashikuni Y, Hirata Y, Nishimoto S, Yagi S, Yamada H, Soeki T, Wakatsuki T, Shimabukuro M, Sata M. Rivaroxaban, a novel oral anticoagulant, attenuates atherosclerotic plaque progression and destabilization in ApoE-deficient mice. Atherosclerosis 2015; 242:639-46. [PMID: 25817329 DOI: 10.1016/j.atherosclerosis.2015.03.023] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 02/18/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Activated factor X (FXa) plays a key role in the coagulation cascade, whereas accumulating evidence suggests that it also contributes to the pathophysiology of chronic inflammation on the vasculature. In this study, we assessed the hypothesis that rivaroxaban (Riv), a direct FXa inhibitor, inhibits atherogenesis by reducing macrophage activation. METHODS AND RESULTS Expression levels of PAR-1 and PAR-2, receptors for FXa, increased in the aorta of apolipoprotein E-deficient (ApoE(-/-)) mice compared with wild-type mice (P < 0.01, P < 0.05, respectively). Administration of Riv (5 mg/kg/day) for 20 weeks to 8-week-old ApoE(-/-) mice reduced atherosclerotic lesion progression in the aortic arch as determined by en-face Sudan IV staining compared with the non-treated group (P < 0.05) without alteration of plasma lipid levels and blood pressure. Histological analyses demonstrated that Riv significantly decreased lipid deposition, collagen loss, macrophage accumulation and matrix metallopeptidase-9 (MMP-9) expression in atherosclerotic plaques in the aortic root. Quantitative RT-PCR analyses using abdominal aorta revealed that Riv significantly reduced mRNA expression of inflammatory molecules, such as MMP-9, tumor necrosis factor-α (TNF-α). In vitro experiments using mouse peritoneal macrophages or murine macrophage cell line RAW264.7 demonstrated that FXa increased mRNA expression of inflammatory molecules (e.g., interleukin (IL)-1β and TNF-α), which was blocked in the presence of Riv. CONCLUSIONS Riv attenuates atherosclerotic plaque progression and destabilization in ApoE(-/-) mice, at least in part by inhibiting pro-inflammatory activation of macrophages. These results indicate that Riv may be particularly beneficial for the management of atherosclerotic diseases, in addition to its antithrombotic activity.
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Affiliation(s)
- Tomoya Hara
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Daiju Fukuda
- Department of Cardio-Diabetes Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
| | - Kimie Tanaka
- Division for Health Service Promotion, The University of Tokyo, Tokyo, Japan
| | | | - Yoichiro Hirata
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Sachiko Nishimoto
- Department of Nutrition and Metabolism, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Michio Shimabukuro
- Department of Cardio-Diabetes Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
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