Dual-pathway Inhibition with Low-dose Aspirin and Rivaroxaban versus Aspirin Monotherapy in Patients with Coronary Artery Disease and Peripheral Artery Disease: Systematic Literature Review and Meta-analysis
Background: Low-dose aspirin lowers cardiovascular event risk; dual-pathway inhibition (DPI) using low-dose aspirin with low-dose rivaroxaban may reduce this risk further. A systematic literature review and meta-analysis compared the efficacy, safety and net clinical benefit (NCB) of DPI with aspiri...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Radcliffe Medical Media
2024-04-01
|
| Series: | European Cardiology Review |
| Online Access: | https://www.ecrjournal.com/articleindex/ecr.2023.40 |
| _version_ | 1826933112025645056 |
|---|---|
| author | Dirk Sibbing Michael J Blaha Rajinder Chawla Augusto Lavalle-Cobo Amit Kishore Angel Lanas Li Li Francesca Santilli Oliver Schnell Zhongwei Shi |
| author_facet | Dirk Sibbing Michael J Blaha Rajinder Chawla Augusto Lavalle-Cobo Amit Kishore Angel Lanas Li Li Francesca Santilli Oliver Schnell Zhongwei Shi |
| author_sort | Dirk Sibbing |
| collection | DOAJ |
| description | Background: Low-dose aspirin lowers cardiovascular event risk; dual-pathway inhibition (DPI) using low-dose aspirin with low-dose rivaroxaban may reduce this risk further. A systematic literature review and meta-analysis compared the efficacy, safety and net clinical benefit (NCB) of DPI with aspirin. Methods: PubMed and Embase were searched for randomised controlled trials reporting clinical efficacy, safety and NCB of DPI compared with aspirin alone in patients with coronary artery disease (CAD) and/or peripheral artery disease. Six articles representing four trials were included. Results: DPI versus aspirin alone significantly reduced major adverse cardiovascular events (HR 0.77; 95% CI [0.69–0.87]; p<0.01), increased International Society on Thrombosis and Haemostasis major bleeding events (HR 1.67; 95% CI [1.37–2.02]; p<0.01) and resulted in a significant NCB (HR 0.79; 95% CI [0.70–0.90]; p<0.01). Conclusion: These results underscore the potential benefit of DPI in patients with CAD, including those in the immediate post-acute coronary syndrome stage and with established CAD, as well as patients with peripheral artery disease. |
| first_indexed | 2024-04-24T07:24:09Z |
| format | Article |
| id | doaj.art-2241cbb1ff7d45f68c08694d5cded231 |
| institution | Directory Open Access Journal |
| issn | 1758-3756 1758-3764 |
| language | English |
| last_indexed | 2025-02-17T17:26:49Z |
| publishDate | 2024-04-01 |
| publisher | Radcliffe Medical Media |
| record_format | Article |
| series | European Cardiology Review |
| spelling | doaj.art-2241cbb1ff7d45f68c08694d5cded2312024-12-14T16:04:58ZengRadcliffe Medical MediaEuropean Cardiology Review1758-37561758-37642024-04-011910.15420/ecr.2023.40Dual-pathway Inhibition with Low-dose Aspirin and Rivaroxaban versus Aspirin Monotherapy in Patients with Coronary Artery Disease and Peripheral Artery Disease: Systematic Literature Review and Meta-analysisDirk Sibbing0Michael J Blaha1Rajinder Chawla2Augusto Lavalle-Cobo3Amit Kishore4Angel Lanas5Li Li6Francesca Santilli7Oliver Schnell8Zhongwei Shi9Department of Internal Medicine, Ludwig-Maximilians-University, Munich, Germany; Privatklinik Lauterbacher Mühle am Ostersee, Seeshaupt, GermanyJohns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medicine, Baltimore, MD, USAccuScript Consultancy, Ludhiana, IndiaCardiology Centre, Sanatorio Otamendi, Buenos Aires, ArgentinaAccuScript Consultancy, Ludhiana, IndiaSchool of Medicine, University of Zaragoza, Zaragoza, Spain; IIS Aragón, Zaragoza, Spain; CIBEREHD, CIBER, Zaragoza, SpainMedical Affairs and Pharmacovigilance, Pharmaceuticals, Bayer AG, Berlin, GermanyDepartment of Medicine and Aging, D’Annunzio University of Chieti-Pescara, Chieti, Italy; Center for Advanced Studies and Technology, D’Annunzio University of Chieti-Pescara, Chieti, ItalyForschergruppe Diabetes e.V., Munich Helmholtz Center, Munich-Neuherberg, GermanyRuijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaBackground: Low-dose aspirin lowers cardiovascular event risk; dual-pathway inhibition (DPI) using low-dose aspirin with low-dose rivaroxaban may reduce this risk further. A systematic literature review and meta-analysis compared the efficacy, safety and net clinical benefit (NCB) of DPI with aspirin. Methods: PubMed and Embase were searched for randomised controlled trials reporting clinical efficacy, safety and NCB of DPI compared with aspirin alone in patients with coronary artery disease (CAD) and/or peripheral artery disease. Six articles representing four trials were included. Results: DPI versus aspirin alone significantly reduced major adverse cardiovascular events (HR 0.77; 95% CI [0.69–0.87]; p<0.01), increased International Society on Thrombosis and Haemostasis major bleeding events (HR 1.67; 95% CI [1.37–2.02]; p<0.01) and resulted in a significant NCB (HR 0.79; 95% CI [0.70–0.90]; p<0.01). Conclusion: These results underscore the potential benefit of DPI in patients with CAD, including those in the immediate post-acute coronary syndrome stage and with established CAD, as well as patients with peripheral artery disease.https://www.ecrjournal.com/articleindex/ecr.2023.40 |
| spellingShingle | Dirk Sibbing Michael J Blaha Rajinder Chawla Augusto Lavalle-Cobo Amit Kishore Angel Lanas Li Li Francesca Santilli Oliver Schnell Zhongwei Shi Dual-pathway Inhibition with Low-dose Aspirin and Rivaroxaban versus Aspirin Monotherapy in Patients with Coronary Artery Disease and Peripheral Artery Disease: Systematic Literature Review and Meta-analysis European Cardiology Review |
| title | Dual-pathway Inhibition with Low-dose Aspirin and Rivaroxaban versus Aspirin Monotherapy in Patients with Coronary Artery Disease and Peripheral Artery Disease: Systematic Literature Review and Meta-analysis |
| title_full | Dual-pathway Inhibition with Low-dose Aspirin and Rivaroxaban versus Aspirin Monotherapy in Patients with Coronary Artery Disease and Peripheral Artery Disease: Systematic Literature Review and Meta-analysis |
| title_fullStr | Dual-pathway Inhibition with Low-dose Aspirin and Rivaroxaban versus Aspirin Monotherapy in Patients with Coronary Artery Disease and Peripheral Artery Disease: Systematic Literature Review and Meta-analysis |
| title_full_unstemmed | Dual-pathway Inhibition with Low-dose Aspirin and Rivaroxaban versus Aspirin Monotherapy in Patients with Coronary Artery Disease and Peripheral Artery Disease: Systematic Literature Review and Meta-analysis |
| title_short | Dual-pathway Inhibition with Low-dose Aspirin and Rivaroxaban versus Aspirin Monotherapy in Patients with Coronary Artery Disease and Peripheral Artery Disease: Systematic Literature Review and Meta-analysis |
| title_sort | dual pathway inhibition with low dose aspirin and rivaroxaban versus aspirin monotherapy in patients with coronary artery disease and peripheral artery disease systematic literature review and meta analysis |
| url | https://www.ecrjournal.com/articleindex/ecr.2023.40 |
| work_keys_str_mv | AT dirksibbing dualpathwayinhibitionwithlowdoseaspirinandrivaroxabanversusaspirinmonotherapyinpatientswithcoronaryarterydiseaseandperipheralarterydiseasesystematicliteraturereviewandmetaanalysis AT michaeljblaha dualpathwayinhibitionwithlowdoseaspirinandrivaroxabanversusaspirinmonotherapyinpatientswithcoronaryarterydiseaseandperipheralarterydiseasesystematicliteraturereviewandmetaanalysis AT rajinderchawla dualpathwayinhibitionwithlowdoseaspirinandrivaroxabanversusaspirinmonotherapyinpatientswithcoronaryarterydiseaseandperipheralarterydiseasesystematicliteraturereviewandmetaanalysis AT augustolavallecobo dualpathwayinhibitionwithlowdoseaspirinandrivaroxabanversusaspirinmonotherapyinpatientswithcoronaryarterydiseaseandperipheralarterydiseasesystematicliteraturereviewandmetaanalysis AT amitkishore dualpathwayinhibitionwithlowdoseaspirinandrivaroxabanversusaspirinmonotherapyinpatientswithcoronaryarterydiseaseandperipheralarterydiseasesystematicliteraturereviewandmetaanalysis AT angellanas dualpathwayinhibitionwithlowdoseaspirinandrivaroxabanversusaspirinmonotherapyinpatientswithcoronaryarterydiseaseandperipheralarterydiseasesystematicliteraturereviewandmetaanalysis AT lili dualpathwayinhibitionwithlowdoseaspirinandrivaroxabanversusaspirinmonotherapyinpatientswithcoronaryarterydiseaseandperipheralarterydiseasesystematicliteraturereviewandmetaanalysis AT francescasantilli dualpathwayinhibitionwithlowdoseaspirinandrivaroxabanversusaspirinmonotherapyinpatientswithcoronaryarterydiseaseandperipheralarterydiseasesystematicliteraturereviewandmetaanalysis AT oliverschnell dualpathwayinhibitionwithlowdoseaspirinandrivaroxabanversusaspirinmonotherapyinpatientswithcoronaryarterydiseaseandperipheralarterydiseasesystematicliteraturereviewandmetaanalysis AT zhongweishi dualpathwayinhibitionwithlowdoseaspirinandrivaroxabanversusaspirinmonotherapyinpatientswithcoronaryarterydiseaseandperipheralarterydiseasesystematicliteraturereviewandmetaanalysis |