![]() 2.7% RR, 1.38 P = 0.001), but no significant increase in life -threatening bleeding or hemorrhagic stroke. The CURE trial demonstrated in 1 2 56 2 patients with a recent acute coronary syndrome (ACS) that the combination of clopidogrel and aspirin, compared to aspirin alone, reduced the risk of CV death, myocardial infarction (MI), or stroke by 20% (relative risk, 0.80 95% confidence interval, 0.72 –0.90 P <0.001), at the cost of a 38% increase in the risk of major bleeding (3.7% v s. ![]() Evidence for dual antiplatelet therapy (DAPT) Recent acute event Efforts to improve the efficacy of single -agent antiplatelet therapy for cardiovascular prevention have focused on intensified therapy with a combination of antiplatelet drugs, most commonly aspirin, and a P2Y1 2 inhibitor, and more recently with the combination of antiplatelet and anticoagulant therapy. Single -agent antiplatelet therapy is effective for prevention of recurrent cardiovascular events in patients with a recent acute atherothrombotic event and those with chronic disease. Plaque growth and fissuring or rupture with superimposed thrombus formation can impair blood flow leading to the clinical manifestations of acute or chronic tissue ischemia, including coronary, cerebral, or peripheral arterial events. Pathophysiology of atherosclerotic cardiovascular diseaseĪtherosclerosis is an inflammatory disease resulting from injury to the blood vessel wall induced by smoking, hypertension, dysglycemia, dyslipidemia, and other injurious agents that leads to the accumulation of lipids, macrophages, and lymphocytes within the intima of large arterie s. This review summarizes the rationale and evidence for the use of dual pathway inhibition (DPI), in particular the combination of aspirin and rivaroxaban, for the acute and long -term management of patients with ASCVD. Additional effective therapies that are widely applicable and affordable could help to reduce the growing burden of disease. ![]() Despite lifestyle modification, cardiovascular (CV) risk factor modification, and revascularization procedures to treat severe or symptomatic manifestations of atherosclerotic disease, the burden of CV disease continues to rise, particularly in low- and middle -income countrie s. Most patients with ASCVD present with disease in a single vascular bed, but one in six have clinical evidence of involvement of more than one vascular bed. 6 million in 2019, while years lived with disability increased from 17. Worldwide cardiovascular deaths increased from 12. Further work is required to assess the possible added benefit of combining rivaroxaban with clopidogrel or ticagrelor instead of aspirin.Ītherosclerotic cardiovascular disease (ASCVD), which includes coronary artery disease (CAD), cerebrovascular disease, and peripheral arterial disease (PAD), is the leading cause of morbidity and mortality worldwide and is associated with major and rising healthcare cost s. Additional trials are underway to assess the impact of DPI therapy in other populations of interest, including patients with ACS at high risk of left ventricular thrombus formation, intracranial atherosclerotic disease with recent transient ischemic attack or stroke, peripheral arterial disease with limiting claudication or post lower extremity revascularization, and advanced chronic kidney disease with ASCVD or risk factors for ASCVD. Among patients with chronic ASCVD, those with involvement of two or more vascular beds, heart failure, chronic kidney disease, or diabetes derive the greatest absolute benefit s. Among patients with recent acute coronary syndrome (ACS), those with positive cardiac biomarkers or ST -segment elevation myocardial infarction, or a history of heart failure derive the greatest absolute benefit s. When used in combination, aspirin and low -dose rivaroxaban work synergistically to inhibit platelet activation and thrombin generation, thereby preventing thrombus formation. More recently, however, randomized trials have demonstrated the benefits and cost -effectiveness of a dual pathway inhibition (DPI) strategy in acute and chronic ASCVD. Antiplatelet therapy has long been the mainstay of antithrombotic therapy for the prevention of first -ever and recurrent ASCVD event s. Atherosclerotic cardiovascular disease (ASCVD), which includes coronary artery disease (CAD), cerebrovascular disease, and peripheral arterial disease (PAD) is associated with significant morbidity, mortality, and healthcare cost s. ![]()
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