Parascandolo Eliot, Eisen Alon
Cardiology Department, Rabin Medical Center , Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel.
Expert Rev Cardiovasc Ther. 2020 Sep;18(9):577-585. doi: 10.1080/14779072.2020.1806712. Epub 2020 Sep 5.
Cardiovascular disease is the leading cause of morbidity and mortality in adults in western nations. In the last decades, tremendous research has been conducted in the field of secondary prevention in order to reduce recurrent cardiovascular events. This review summarizes the novel dual pathway concept of aspirin and very low-dose rivaroxaban, from mechanisms to clinical practice.
The COMPASS trial demonstrated that in patients with stable atherosclerotic disease, very low-dose rivaroxaban, a direct factor Xa inhibitor, when combined with aspirin, reduced the rate of recurrent ischemic events, at the cost of increased bleeding. This effect was present in patients with ischemic heart disease, as well as in patients with atherosclerosis in other beds, such as in peripheral arterial disease. Sub-studies from the COMPASS trial examined other high-risk populations who might benefit the most from this regimen.
There are currently multiple antiplatelet and anticoagulation treatment regimens for patients with stable atherosclerotic disease. The dual pathway concept is a novel approach that combines both mechanisms. Identifying patients who might benefit the most in terms of ischemic events at the least bleeding events still remains a challenge, yet prescribing this combination to high-risk patients might be the most effective.
在西方国家，心血管疾病是成年人发病和死亡的主要原因。在过去几十年里，为了减少心血管事件的复发，在二级预防领域开展了大量研究。本综述总结了阿司匹林和极低剂量利伐沙班的新型双重途径概念，从作用机制到临床应用。
COMPASS试验表明，在稳定型动脉粥样硬化疾病患者中，极低剂量的直接Xa因子抑制剂利伐沙班与阿司匹林联合使用时，可降低复发性缺血事件的发生率，但会增加出血风险。这种效果在缺血性心脏病患者以及其他部位存在动脉粥样硬化的患者中均有体现，如外周动脉疾病患者。COMPASS试验的亚组研究考察了其他可能从该治疗方案中获益最大的高危人群。
目前，对于稳定型动脉粥样硬化疾病患者有多种抗血小板和抗凝治疗方案。双重途径概念是一种结合了两种作用机制的新方法。确定哪些患者在缺血事件方面获益最大且出血事件最少仍然是一个挑战，但将这种联合治疗方案应用于高危患者可能是最有效的。
