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Commentary on: Connolly SJ, Eikelboom JW, Bosch J, et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017 S0140-6736:32458-3.
Stable coronary artery disease (CAD), caused by both activation of platelets and the coagulation cascade, is a growing burden in all countries.1 Compared with aspirin, combination therapy with warfarin and aspirin led to additional benefit against recurrent myocardial infarction and death. However, increased serious bleeding, including intracranial haemorrhage, has limited its use in clinical practice.2 To date, studies of the effects of direct anticoagulants, such as rivaroxaban (which inhibits factor Xa), in stable CAD have conflicting results, and their role is still unclear.3 4
An international (33 countries), double-blind, randomised, placebo-controlled trial recruited individuals with stable CAD in the outpatient setting.5 Eligibility criteria were myocardial infarction in the …
Competing interests AB has been an advisory board member for Novo Nordisk and Boehringer Ingelheim.
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Provenance and peer review Commissioned; internally peer reviewed.