XARELTO®: Chronic coronary artery disease and peripheral artery disease treatment

2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes1

Recommendations (excerpt)See full ESC Guidelines at www.escardio.org

Antithrombotic therapy in patients with chronic coronary syndromes and in sinus rhythm

In patients with a high risk of ischemic events and without high bleeding risk§: Adding a second antithrombotic drug to aspirin for long-term secondary prevention should be considered

Class

Evidence Level

lla

A

In patients with at least a moderately increased risk of ischemic events|| and without high bleeding risk§:Adding a second antithrombotic drug to aspirin for long-term secondary prevention may be considered

Class

Evidence Level

llb

A


*Patients with chronic coronary syndromes (chronic CAD) and in sinus rhythm.
Recommended treatment options for dual antithrombotic therapy in combination with aspirin include rivaroxaban, clopidogrel, prasugrel, and ticagrelor.
High ischemic risk was defined as diffuse multivessel CAD with at least 1 of the following: diabetes mellitus requiring medication, recurrent Ml, PAD, or CKD with eGFR 15 mL/min/1.73 m2 to 59 mL/min/1.73 m2.
§High bleeding risk defined as: history of intracerebral hemorrhage or ischemic stroke, history of other intracranial pathology, recent gastrointestinal bleeding or anemia due to possible gastrointestinal blood loss, other gastrointestinal pathology associated with increased bleeding risk, liver failure, bleeding diathesis or coagulopathy, extreme old age or frailty, or renal failure requiring dialysis or with eGFR <15 mL/min/1.73 m2.
Moderate ischemic risk was defined as at least 1 of the following: multivessel/diffuse CAD, diabetes mellitus requiring medication, recurrent Ml, PAD, HF, or CKD with eGFR 15 mL/min/1.73 m2 to 59 mL/min/1.73 m2.

CAD = coronary artery disease; CKD = chronic kidney disease; DOAC = direct oral anticoagulant; eGFR = estimated glomerular filtration rate; ESC = European Society of Cardiology; HF = heart failure; MI = myocardial infarction; PAD = peripheral artery disease.