Antiplatelets for Cardiovascular Disease in Non-valvular AF with Rivaroxaban: A Subanalysis of the EXPAND Study

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Non-valvular atrial fibrillation (NVAF) often coexists with stable coronary artery disease (CAD), ischemic stroke, or peripheral artery disease (PAD).
• Optimal antithrombotic strategies for patients with NVAF and these comorbidities are crucial for balancing efficacy and safety.

Purpose of the Study:

• To evaluate the risks and benefits of rivaroxaban plus antiplatelet therapy (APT) versus rivaroxaban alone in patients with NVAF complicated by stable CAD, ischemic stroke, or PAD.
• To assess the impact of adding APT on ischemic outcomes and bleeding events.

Main Methods:

• Subanalysis of the EXPAND study involving 2,030 patients with NVAF and CAD, ischemic stroke, or PAD.
• Patients received rivaroxaban (10 or 15 mg/day) with or without APT.
• Efficacy outcomes included symptomatic stroke, systemic embolism, myocardial infarction, and cardiovascular death. Safety outcomes comprised major and any bleeding events.

Main Results:

• No significant differences in efficacy outcomes were observed between rivaroxaban plus APT and rivaroxaban alone in the overall cohort or CAD and stroke subgroups.
• The combination therapy showed a trend towards increased all-cause death in the PAD subgroup (HR 4.43 [1.05-18.71]).
• Rivaroxaban plus APT significantly increased any bleeding in the overall cohort (HR 1.28 [1.01-1.62]) and stroke subgroup (HR 1.42 [1.01-2.01]), and major bleeding in the CAD subgroup (HR 2.00 [1.01-3.93]).

Conclusions:

• Rivaroxaban combined with APT did not provide additional ischemic benefits for patients with NVAF and stable CAD or ischemic stroke.
• This combination therapy was associated with an increased risk of bleeding events in patients with NVAF and stable CAD or ischemic stroke.