Introduction

In this review, the role of the rivaroxaban-plus-aspirin approach (dual pathway inhibition – DPI) in patients with chronic coronary syndrome (CCS) and to perform practical recommendations about its use was updated.

Areas covered

The contents of this review were proposed in an expert meeting. To identify relevant articles, a systematic search of Medline/Embase was performed (to July 2019), using the key words ‘rivaroxaban’, ‘vascular dose’, ‘COMPASS’ and ‘coronary artery disease’ in the search strategy.

Expert opinion

Despite current antithrombotic strategies (single/dual antiplatelet therapy) have decreased rates of recurrent cardiovascular events among patients with CCS, residual risk remains unacceptably high. The COMPASS trial showed in CCS patients that compared with aspirin 100 mg rivaroxaban 2.5 mg bid plus aspirin 100 mg reduced the risk of major cardiac events, cardiovascular hospitalization and mortality, without an increase of intracranial or fatal bleedings. Importantly, residual risk with the rivaroxaban plus aspirin approach was lower than with different dual antiplatelet therapy regimens. The rivaroxaban plus aspirin strategy is of particular benefit in patients with CCS and high-risk cardiovascular feature (i.e. ≥2 vascular beds, heart failure, renal insufficiency, peripheral artery disease, previous stroke or diabetes) and should be considered in these populations.

中文翻译：

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慢性冠状动脉综合征患者的残余风险降低机会。双通路抑制的作用。

介绍

在这篇综述中，更新了利伐沙班加阿司匹林方法（双通路抑制 - DPI）在慢性冠状动脉综合征 (CCS) 患者中的作用以及对其使用的实际建议。

涵盖的领域

本次审查的内容是在专家会议上提出的。为了确定相关文章，对 Medline/Embase 进行了系统搜索（至 2019 年 7 月），在搜索策略中使用关键词“利伐沙班”、“血管剂量”、“COMPASS”和“冠状动脉疾病”。

专家意见

尽管目前的抗血栓策略（单/双抗血小板治疗）降低了 CCS 患者的心血管事件复发率，但残余风险仍然高得令人无法接受。COMPASS 试验在 CCS 患者中显示，与阿司匹林 100 mg 利伐沙班 2.5 mg bid 加阿司匹林 100 mg 相比，降低了主要心脏事件、心血管住院和死亡率的风险，而颅内或致命性出血没有增加。重要的是，利伐沙班加阿司匹林方案的残余风险低于不同的双重抗血小板治疗方案。利伐沙班加阿司匹林策略对患有 CCS 和高危心血管特征（即≥2 个血管床、心力衰竭、肾功能不全、外周动脉疾病、