Outcomes of Different Regimens of Rivaroxaban and Aspirin in Cardiovascular Diseases: A Network Meta-Analysis.

Rivaroxaban is widely used to prevent thrombotic events in cardiovascular diseases (CVD). While various doses and combinations with aspirin have been evaluated across CVD subtypes, the optimal regimen remains unclear. This network meta-analysis aims to identify the most effective and safe rivaroxaban regimens, with or without aspirin, for patients with CVD. : A systematic search of PubMed, Scopus, Cochrane Library, and Web of Science identified randomized-controlled trials (RCTs) assessing rivaroxaban, with or without aspirin, in CVD. Key outcomes included thromboembolic, hemorrhagic, and mortality events. A frequentist network meta-analysis (MetaInsight tool) was performed, using aspirin monotherapy as the reference. Subgroup analyses for coronary artery disease (CAD) were conducted. : Seven RCTs were included. Rivaroxaban 2.5 mg twice daily ("bis in die" (BID)) with aspirin showed the most significant venous thromboembolism (VTE) prevention (RR = 0.61, 95% CI [0.43-0.86]) but had the highest major bleeding risk (RR = 1.58, 95% CI [1.26-2]). Rivaroxaban 5 mg BID with aspirin showed the lowest myocardial infarction risk (RR = 0.78). Higher doses (20 mg BID) with aspirin were associated with an increased fatal bleeding risk (RR = 7.14, 95% CI [2.83-17.98]). Rivaroxaban 5 mg BID monotherapy had the highest hemorrhagic stroke risk (RR = 2.7, 95% CI [1.31-5.58]). In CAD, rivaroxaban 2.5 mg BID plus aspirin offered the lowest all-cause mortality (RR = 0.76, 95% CI [0.63-0.93]). : Rivaroxaban 2.5 mg BID plus aspirin reduces VTE and lowers mortality in CAD but carries higher bleeding risks. Optimal regimen selection requires a careful risk-benefit balance.