%0 Journal Article
%T Safety and efficacy of rivaroxaban for the secondary prevention following acute coronary syndromes among biomarker
%A Alexei Plotnikov
%A C Michael Gibson
%A Christoph Bode
%A Eugene Braunwald
%A Freek Verheugt
%A Michal Tendera
%A Paul Burton
%A Purva Jain
%A Serge Korjian
%A Yazan Daaboul
%J European Heart Journal: Acute Cardiovascular Care
%@ 2048-8734
%D 2019
%R 10.1177/2048872617745003
%X Despite dual antiplatelet therapy, persistent thrombin generation and thrombin-mediated platelet activation account in part for the residual risk of atherothrombotic disease among patients with prior acute coronary syndrome (ACS). Inhibition of thrombin generation among high-risk ACS patients (biomarker-positive ACS) with the factor Xa inhibitor rivaroxaban may limit ongoing thrombus formation and myocardial necrosis and thereby improve clinical outcomes. ATLAS ACS 2-TIMI 51 was a double-blind, placebo-controlled clinical trial that randomized ACS patients to either rivaroxaban 2.5 mg b.i.d., rivaroxaban 5 mg b.i.d., or placebo plus standard-of-care antiplatelet therapy for a mean of 13.1 months and up to 31 months (N=15,526). This post-hoc analysis evaluates the safety and efficacy of rivaroxaban among biomarker-positive ACS patients with and without a history of prior stroke of transient ischemic attack in the ATLAS ACS 2-TIMI 51 trial. A total of 12,626 biomarker-positive ACS patients were included in this analysis. Among biomarker-positive patients without a prior history of stroke or transient ischemic attack, rivaroxaban 2.5 b.i.d. was associated with a reduction in the primary efficacy endpoint (composite of cardiovascular death, myocardial infarction, or stroke) as compared with placebo (hazard ratio=0.80, 95% confidence interval (0.68¨C0.94), p=0.007) at the expense of an increase in non-coronary-artery-bypass-graft-related Thrombolysis in Myocardial Infarction major bleeding (1.9% vs. 0.7%, p<0.0001), but not a significant increase in either intracranial hemorrhage (0.4% vs. 0.2%, p=0.11) or fatal bleeding (0.1% vs. 0.3%, p=0.16). Rivaroxaban 2.5 mg b.i.d. was associated with a significant reduction in the composite of cardiovascular death, myocardial infarction, or stroke with no increase in fatal bleeding. Biomarker-positive patients with no prior history of stroke or transient ischemic attack may be a optimal target population to receive ¡°dual pathway¡± therapy with rivaroxaban plus dual antiplatelet therapy for secondary prevention following ACS
%K Acute coronary syndrome
%K dual antiplatelet therapy
%K dual pathway
%K rivaroxaban
%K novel oral anticoagulants
%K secondary prevention
%K biomarker positive
%K stroke
%U https://journals.sagepub.com/doi/full/10.1177/2048872617745003