Clinical Performance and Persistence on Dual Pathway Inhibition with Rivaroxaban and Aspirin in Real-World Setting

Area of Science:

• Cardiology
• Vascular Medicine
• Pharmacology

Background:

• Dual pathway inhibition (DPI) with low-dose rivaroxaban and aspirin demonstrates efficacy in reducing cardiovascular events in stable atherosclerotic vascular disease.
• Real-world data on the clinical performance, adherence, and persistence of DPI therapy in patients with coronary artery disease (CAD) and peripheral artery disease (PAD) is limited.

Purpose of the Study:

• To evaluate the real-world clinical performance, adherence, and persistence of DPI therapy in patients diagnosed with CAD and/or PAD.
• To assess the safety profile, including bleeding events, associated with DPI therapy in this patient population.

Main Methods:

• Prospective observational study including consecutive patients with established CAD and/or PAD treated with aspirin (100 mg daily) and rivaroxaban (2.5 mg twice daily).
• Clinical evaluations were conducted at baseline, 1 month, and every 6 months post-initiation of DPI therapy.
• Data collected included adherence, persistence, and incidence of major and minor bleeding events, as well as major adverse cardiovascular events.

Main Results:

• A total of 202 patients were included, with a mean follow-up of 664 days.
• The incidence rate of major bleeding was 0.8 per 100 patients/year, and major adverse cardiovascular events was 1.1 per 100 patients/year.
• Adherence to pharmacological treatment was high at 99%, with 13.4% of patients discontinuing DPI therapy, primarily due to minor bleedings.

Conclusions:

• DPI with low-dose rivaroxaban and aspirin is safe and effective in a real-world setting for patients with CAD and PAD.
• The therapy demonstrates high persistence and adherence, with a low incidence of major bleeding events.
• Minor bleedings were the main reason for treatment discontinuation, highlighting the importance of monitoring and management.