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General medicine
There may be a role for addition of rivaroxaban to aspirin in patients with stable coronary artery disease
  1. Amitava Banerjee
  1. Farr Institute of Health Informatics, University College London, London, UK
  1. Correspondence to Dr Amitava Banerjee, Farr Institute of Health Informatics, University College London, London WC1E 6BT, UK; ami.banerjee{at}

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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 …

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  • Competing interests AB has been an advisory board member for Novo Nordisk and Boehringer Ingelheim.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.