Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
Pol Arch Intern Med. 2023 Oct 26;133(10). doi: 10.20452/pamw.16566. Epub 2023 Sep 21.
Despite availability of effective preventive therapies based on guidelines, patients with vascular diseases continue to be at a high risk for recurrent ischemic events. Therefore, novel therapeutic strategies are required to further reduce the residual risk present in these patients. Platelet aggregation and fibrin organization are involved in arterial thrombosis. Rivaroxaban is capable of targeting both processes and has a synergistic effect when used in combination with acetylsalicylic acid (ASA), providing the so‑called dual pathway inhibition (DPI). The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial showed that the DPI (a combination of rivaroxaban at 2.5 mg twice daily [vascular dose] and ASA at 100 mg once daily) reduced cardiovascular death, stroke, or myocardial infarction by 24% in patients with chronic coronary artery disease (CAD) and peripheral artery disease (PAD). Subsequently, the VOYAGER PAD (Vascular Outcomes Study of ASA Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) trial confirmed the effectiveness of the vascular dose of rivaroxaban in patients with PAD after lower‑extremity revascularization, as compared with ASA alone. Therefore, DPI is recommended in the patients with CAD (+/- PAD) or symptomatic PAD at a high risk of ischemia. The purpose of this review is to examine the clinical benefits and practical implications of DPI in the CAD and PAD patients.
尽管有基于指南的有效预防疗法，但血管疾病患者仍存在发生复发性缺血事件的高风险。因此，需要新的治疗策略来进一步降低这些患者的残余风险。血小板聚集和纤维蛋白组织参与动脉血栓形成。利伐沙班能够针对这两个过程，与乙酰水杨酸（ASA）联合使用具有协同作用，提供所谓的双重途径抑制（DPI）。COMPASS（使用抗凝策略的人心血管结果）试验表明，DPI（每日两次 2.5 mg 的利伐沙班和每日一次 100 mg 的 ASA 的组合）可使慢性冠状动脉疾病（CAD）和外周动脉疾病（PAD）患者的心血管死亡、中风或心肌梗死风险降低 24%。随后，VOYAGER PAD（ASA 联合利伐沙班用于 PAD 血管内或手术肢体血运重建的血管结局研究）试验证实了血管剂量的利伐沙班在下肢血运重建后对 PAD 患者的有效性，优于单独使用 ASA。因此，建议在 CAD（+/- PAD）或有缺血高风险的有症状 PAD 患者中使用 DPI。本综述的目的是探讨 DPI 在 CAD 和 PAD 患者中的临床获益和实际意义。
