Efficacy and safety of rivaroxaban monotherapy in stable coronary heart disease and atrial fibrillation: 616‐005:616.151.5

Abstract

Summary. The antithrombotic therapy for the combination of atrial fibrillation (AF) and coronary heart disease (CНD) represents a complex clinical challenge that requires a meticulous evaluation of the thrombosis and bleeding risks for each patient. The combination of anticoagulants and antiplatelet agents, as currently recommended in guidelines, is associated with an increased risk of bleeding. Therefore, the scientific community is constantly searching for new effective and safe antithrombotic treatments for this complex patient population. In 2019, the results of the multicenter randomized study AFIRE were published. The study investigated the potential of rivaroxaban monotherapy in patients with AF who had undergone percutaneous coronary intervention or cardiopulmonary bypass surgery more than 1 year earlier or who had angiographically confirmed CНD not requiring revascularization. Rivaroxaban has been shown to be noninferior to combination therapy of rivaroxaban with an antiplatelet agent (acetylsalicylic acid or P2Y12 inhibitor) in terms of efficacy and superior to it in terms of safety. In 2021–2023, data from this study re‐analyzed with a particular focus on patients with additional risk factors for thrombosis or bleeding. This resulted in an expansion of knowledge regarding the effectiveness and safety of rivaroxaban. This review aims to systematize the findings and provide comprehensive information on clinical situations in which rivaroxaban monotherapy is preferable to combination therapy. The presented rivaroxaban treatment regimen was found to be optimal for patients after coronary stenting, with heart failure, thrombocytopenia, and the presence of a previous atherothrombotic disease. In addition, the benefits of monotherapy are not contingent on body mass index (possible use in overweight or underweight patients) nor on the risk of stroke and bleeding, which were assessed using the CHADS2 scale, CHA2DS2‐VASc and HAS‐BLED scores.

For citation: Gribkova I.V. Efficacy and safety of rivaroxaban monotherapy in stable coronary heart disease and atrial fibrillation. Tromboz, gemostaz i reologiya. 2024;(3):13–18. (In Russ.).

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