Dual Antithrombotic vs. Dual Antiplatelet Strategy After Acute Coronary Syndrome

Although dual antiplatelet therapy (DAPT) with a P2Y₁₂ inhibitor (clopidogrel, prasugrel, or ticagrelor) and aspirin is the standard of care after an acute coronary syndrome (ACS), major cardiovascular events still occur after ACS in almost 10% of patients. Adding low-dose rivaroxaban, an anticoagulant, to DAPT resulted in a decrease in ischemic outcomes but increased major bleeding events (NEJM JW Cardiol Jan 2012 and N Engl J Med 2012; 366:9). To explore the effects on bleeding outcomes of replacing one antiplatelet agent with an anticoagulant, investigators conducted an industry-funded, double-blind, randomized trial (NCT02293395) of aspirin versus low-dose rivaroxaban in 3037 ACS patients who were taking a P2Y₁₂ inhibitor (mean age, 63;…