Low Dose Rivaroxaban for Atherosclerotic Cardiovascular Diseases: A Systematic Review and Meta-analysis

被引:7
作者
Chen, Can [1 ]
Kan, Yuanqing [2 ]
Shi, Zhenyu [2 ]
Guo, Daqiao [2 ]
Fu, Weiguo [2 ]
Li, Yanli [1 ]
Lv, Qianzhou [1 ]
Li, Xiaoyu [1 ]
Si, Yi [2 ]
机构
[1] Fudan Univ, Zhongshan Hosp, Dept Pharm, Shanghai, Peoples R China
[2] Fudan Univ, Zhongshan Hosp, Dept Vasc Surg, Shanghai, Peoples R China
关键词
rivaroxaban; low dose; atherosclerosis; cardiovascular diseases; systematic review; randomized controlled studies; ACUTE CORONARY SYNDROME; DUAL ANTIPLATELET THERAPY; MYOCARDIAL-INFARCTION TIMI; ARTERY-DISEASE; DOUBLE-BLIND; PLASMINOGEN-ACTIVATOR; XA INHIBITORS; ASPIRIN; EFFICACY; PLACEBO;
D O I
10.3389/fphar.2020.608247
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Background: This study aims to explore the role of low-dose rivaroxaban (<= 10 mg daily) for the treatment of atherosclerotic cardiovascular disease (ASCVD). Methods: PubMed, Embase and the Cochrane Library were searched for randomized controlled trials (RCTs) of low-dose rivaroxaban in patients with ASCVD including coronary artery disease (CAD) and peripheral artery disease (PAD). Literature screening, data extraction, and risk of bias assessment were carried out independently by two researchers. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using random-effect models to determine risks of outcomes in ASCVD patients treated with rivaroxaban and comparators, and meta-analysis was conducted via Review Manager 5.3.5 software. Results: 3,768 records were obtained through literature search, and 9 articles representing 6 RCTs ultimately qualified for this study. The meta-analysis indicated that for patients with CAD, the addition of rivaroxaban (5 mg daily) to aspirin could significantly reduce the risk of major adverse cardiovascular events (MACEs) compared with aspirin alone (HR 0.81, 95% CI, 0.72 to 0.91, p = 0.0004, I-2 = 60%, 4 studies). For PAD patients receiving rivaroxaban (5 mg daily) plus aspirin, there was no significant reduction in the risk of MACEs (HR 0.84, 95% CI, 0.63 to 1.13, p = 0.25, I-2 = 74%, 2 studies); however, there was significant reduction in major adverse limb events (MALEs) (HR 0.54, 95% CI, 0.35 to 0.83, p = 0.005, one studies) and in the composite of MACEs or MALEs (HR 0.78, 95% CI, 0.64 to 0.95, p = 0.02, I-2 = 66%, 2 studies) when compared with patients receiving aspirin alone. Meanwhile, rivaroxaban combined with aspirin significantly increased the risk of International Society on Thrombosis and Haemostasis (ISTH) major bleeding compared with aspirin alone in patients with CAD (HR 1.74, 95% CI, 1.43 to 2.13, p < 0.00001, I-2 = 0%, 2 studies) and PAD (HR 1.47, 95% CI, 1.19 to 1.83, p = 0.0004, I-2 = 0%, 2 studies). Conclusions: Compared with standard antiplatelet therapy, the addition of a 5 mg daily dose of rivaroxaban to standard antiplatelet therapy may improve cardiovascular or limb outcomes of patients with ASCVD, with an increase in major bleeding. Patients who would benefit from the addition of low-dose rivaroxaban to antiplatelet agents and appropriate dual-pathway antithrombotic strategies should be identified in clinical practice to individualize antithrombotic therapy.
引用
收藏
页数:12
相关论文
共 46 条
[1]   Apixaban with Antiplatelet Therapy after Acute Coronary Syndrome [J].
Alexander, John H. ;
Lopes, Renato D. ;
James, Stefan ;
Kilaru, Rakhi ;
He, Yaohua ;
Mohan, Puneet ;
Bhatt, Deepak L. ;
Goodman, Shaun ;
Verheugt, Freek W. ;
Flather, Marcus ;
Huber, Kurt ;
Liaw, Danny ;
Husted, Steen E. ;
Lopez-Sendon, Jose ;
De Caterina, Raffaele ;
Jansky, Petr ;
Darius, Harald ;
Vinereanu, Dragos ;
Cornel, Jan H. ;
Cools, Frank ;
Atar, Dan ;
Luis Leiva-Pons, Jose ;
Keltai, Matyas ;
Ogawa, Hisao ;
Pais, Prem ;
Parkhomenko, Alexander ;
Ruzyllo, Witold ;
Diaz, Rafael ;
White, Harvey ;
Ruda, Mikhail ;
Geraldes, Margarida ;
Lawrence, Jack ;
Harrington, Robert A. ;
Wallentin, Lars .
NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (08) :699-708
[2]   Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial [J].
Anand, Sonia S. ;
Bosch, Jackie ;
Eikelboom, John W. ;
Connolly, Stuart J. ;
Diaz, Rafael ;
Widimsky, Peter ;
Aboyans, Victor ;
Alings, Marco ;
Kakkar, Ajay K. ;
Keltai, Katalin ;
Maggioni, Aldo P. ;
Lewis, Basil S. ;
Stoerk, Stefan ;
Zhu, Jun ;
Lopez-Jaramillo, Patricio ;
O'Donnell, Martin ;
Commerford, Patrick J. ;
Vinereanu, Dragos ;
Pogosova, Nana ;
Ryden, Lars ;
Fox, Keith A. A. ;
Bhatt, Deepak L. ;
Misselwitz, Frank ;
Varigos, John D. ;
Vanassche, Thomas ;
Avezum, Alvaro A. ;
Chen, Edmond ;
Branch, Kelley ;
Leong, Darryl P. ;
Bangdiwala, Shrikant I. ;
Hart, Robert G. ;
Yusuf, Salim .
LANCET, 2018, 391 (10117) :219-229
[3]  
[Anonymous], 2014, REV MAN REVMAN COMP
[4]  
Baigent C, 2002, BMJ-BRIT MED J, V324, P71, DOI 10.1136/bmj.324.7329.71
[5]   A systematic review of the efficacy of aspirin monotherapy versus other antiplatelet therapy regimens in peripheral arterial disease [J].
Beiswenger, Ashlei C. ;
Jo, Alice ;
Harth, Karem ;
Kumins, Norman H. ;
Shishehbor, Mehdi H. ;
Kashyap, Vikram S. .
JOURNAL OF VASCULAR SURGERY, 2018, 67 (06) :1922-+
[6]   Role of Combination Antiplatelet and Anticoagulation Therapy in Diabetes Mellitus and Cardiovascular Disease Insights From the COMPASS Trial [J].
Bhatt, Deepak L. ;
Eikelboom, John W. ;
Connolly, Stuart J. ;
Steg, P. Gabriel ;
Anand, Sonia S. ;
Verma, Subodh ;
Branch, Kelley R. H. ;
Probstfield, Jeffrey ;
Bosch, Jackie ;
Shestakovska, Olga ;
Szarek, Michael ;
Maggioni, Aldo Pietro ;
Widimsky, Petr ;
Avezum, Alvaro ;
Diaz, Rafael ;
Lewis, Basil S. ;
Berkowitz, Scott D. ;
Fox, Keith A. A. ;
Ryden, Lars ;
Yusuf, Salim .
CIRCULATION, 2020, 141 (23) :1841-1854
[7]   Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI): a phase 3, placebo-controlled, randomised trial [J].
Bhatt, Deepak L. ;
Steg, Philippe Gabriel ;
Mehta, Shamir R. ;
Leiter, Lawrence A. ;
Simon, Tabassome ;
Fox, Kim ;
Held, Claes ;
Andersson, Marielle ;
Himmelmann, Anders ;
Ridderstrale, Wilhelm ;
Chen, Jersey ;
Song, Yang ;
Diaz, Rafael ;
Goto, Shinya ;
James, Stefan K. ;
Ray, Kausik K. ;
Parkhomenko, Alexander N. ;
Kosiborod, Mikhail N. ;
McGuire, Darren K. ;
Harrington, Robert A. .
LANCET, 2019, 394 (10204) :1169-1180
[8]   Comparative Determinants of 4-Year Cardiovascular Event Rates in Stable Outpatients at Risk of or With Atherothrombosis [J].
Bhatt, Deepak L. ;
Eagle, Kim A. ;
Ohman, E. Magnus ;
Hirsch, Alan T. ;
Goto, Shinya ;
Mahoney, Elizabeth M. ;
Wilson, Peter W. F. ;
Alberts, Mark J. ;
D'Agostino, Ralph ;
Liau, Chiau-Suong ;
Mas, Jean-Louis ;
Roether, Joachim ;
Smith, Sidney C., Jr. ;
Salette, Genevieve ;
Contant, Charles F. ;
Massaro, Joseph M. ;
Steg, Ph. Gabriel .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2010, 304 (12) :1350-1357
[9]   Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events [J].
Bhatt, DL ;
Fox, KAA ;
Hacke, W ;
Berger, PB ;
Black, HR ;
Boden, WE ;
Cacoub, P ;
Cohen, EA ;
Creager, MA ;
Easton, JD ;
Flather, MD ;
Haffner, SM ;
Hamm, CW ;
Hankey, GJ ;
Johnston, SC ;
Mak, KH ;
Mas, JL ;
Montalescot, G ;
Pearson, TA ;
Steg, PG ;
Steinhubl, SR ;
Weber, MA ;
Brennan, DM ;
Fabry-Ribaudo, L ;
Booth, J ;
Topol, EJ ;
Frye, RL ;
Amarenco, P ;
Brass, LM ;
Buyse, M ;
Cohen, LS ;
DeMets, DL ;
Fuster, V ;
Hart, RG ;
Marler, JR ;
McCarthy, C ;
Schoemig, A ;
Lincoff, AM ;
Brener, SJ ;
Sila, CA ;
Albuquerque, A ;
Aroutiounov, G ;
Artemiev, D ;
Atkeson, BG ;
Bartel, T ;
Basart, DCG ;
Lima, AB ;
Belli, G ;
Bordalo e Sa, AL ;
Bosch, X .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 354 (16) :1706-1717
[10]   Rivaroxaban in Peripheral Artery Disease after Revascularization [J].
Bonaca, Marc P. ;
Bauersachs, Rupert M. ;
Anand, Sonia S. ;
Debus, E. Sebastian ;
Nehler, Mark R. ;
Patel, Manesh R. ;
Fanelli, Fabrizio ;
Capell, Warren H. ;
Diao, Lihong ;
Jaeger, Nicole ;
Hess, Connie N. ;
Pap, Akos F. ;
Kittelson, John M. ;
Gudz, Ivan ;
Matyas, Lajos ;
Krievins, Dainis K. ;
Diaz, Rafael ;
Brodmann, Marianne ;
Muehlhofer, Eva ;
Haskell, Lloyd P. ;
Berkowitz, Scott D. ;
Hiatt, William R. .
NEW ENGLAND JOURNAL OF MEDICINE, 2020, 382 (21) :1994-2004