The role of rivaroxaban in the management of coronary artery disease: an overview of five landmark clinical trials.

Globally, coronary artery disease (CAD) continues to be a major cause of morbidity and death. The intricate relationship between thrombosis and atherosclerosis means that even though antiplatelet therapy (APT) has long been the mainstay of secondary prevention, there is still a considerable residual risk of ischemic events. One promising treatment option to address this lingering risk is rivaroxaban, a strong, selective Factor Xa inhibitor and direct oral anticoagulant (DOAC). The evidence currently available on the use of low-dose rivaroxaban in conjunction with APT for secondary prevention in a variety of high-risk CAD patient profiles is summarized in this mini-review. In this review, we discuss how it works, the important clinical studies that proved its usefulness, and its effectiveness and safety in particular patient subgroups, such as those undergoing percutaneous coronary intervention (PCI), those with a history of myocardial infarction (MI), and those with comorbid diabetes mellitus (DM). At the expense of a higher but controllable bleeding risk, mostly non-intracranial, the review emphasizes the strong evidence from seminal trials such as COMPASS and ATLAS ACS 2-TIMI 51, showing that the addition of a vascular dose of rivaroxaban (2.5 mg twice daily) to aspirin significantly lowers the composite of cardiovascular death, myocardial infarction, and stroke. The net clinical benefit of this treatment approach is also reviewed, with a focus on the significance of cautious patient selection to optimize ischemic risk reduction and minimize bleeding complications.