Summary: Civilization diseases, including atherosclerosis manifested in various vascular areas, are a key cause of morbidity and mortality, and optimal pharmacotherapy, in addition to lifestyle modification, is an integral component of primary and secondary prevention of cardiovascular events and death. Patients with atherosclerotic cardiovascuar disease (ASCVD), despite the availability of effective guideline-based therapies, still face an unacceptably high risk of recurrent ischemic events. This results in the need for new therapeutic strategies to reduce residual risk.
Platelet aggregation and plasma hemostatic processes leading to fibrin formation are involved in arterial thrombosis and thus ischemic incidents such as myocardial infarction, stroke, mesenteric thrombosis or critical lower extremity ischemia. As a factor Xa inhibitor, rivaroxaban is able to pharmacologically target both of these processes and simultaneously exhibit a synergistic effect when combined with acetylsalicylic acid (ASA) without significantly increasing the risk of fatal bleeding. The COMPASS trial showed that the combination of rivaroxaban 2 × 2.5 mg/day with ASA 1 × 100 mg/day leads to a 24% reduction in cardiovascular mortality, ischemic stroke or myocardial infarction in patients with chronic ischemic heart disease (CAD) and peripheral artery disease (PAD). Subsequently, the VOYAGER PAD trial confirmed the superior efficacy of this dose of rivaroxaban in patients with PAD after lower extremity revascularization, compared to ASA monotherapy. Optimal antiplatelet and anticoagulant treatment, given the number of completed and ongoing clinical trials, represents a significant challenge for the practicing physician who wants to optimally protect a patient with atherosclerosis manifesting in specific vascular areas. This study presents the current state of knowledge in this area. The potential clinical benefits and possible risks of a new therapeutic standard involving the combination of low-dose rivaroxaban (2 × 2.5 mg/ day) with ASA as part of antiplatelet/antithrombotic therapy in patients with ASCVD are synthetically presented.