Low-Dose Rivaroxaban vs. Aspirin in Addition to Clopidogrel After Percutaneous Coronary Intervention in Coronary Atherosclerotic Heart Disease Patients with Gastrointestinal Disease

• DOI: 10.1007/s10557-025-07682-5
• Publication Date: 2025-03-22T20:40:02Z
• Authors: Yue Li; Tienan Zhou; Yan Liu; Junxian Qi; Lei Zhang; Ruoxi Gu; Dongyuan Sun; Xiaozeng Wang
• Keywords: Stroke

Abstract Purpose Dual antiplatelet therapy (DAPT) is the cornerstone for patients with coronary atherosclerotic heart disease (CHD) undergoing percutaneous intervention (PCI) while increasing risk of bleeding, particularly when combined gastrointestinal (GID). Rivaroxaban 10 mg once daily widely used in Asia. This study compared effects low-dose rivaroxaban (10 daily) plus clopidogrel vs. DAPT CHD GID PCI. Methods In this prospective, single-center, randomized controlled trial, eligible PCI were (1:1) to either dual pathway inhibition (DPI) group (rivaroxaban 75 or (aspirin 100 daily). The primary outcome was Bleeding Academic Research Consortium (BARC) type 2–5 bleeding. secondary major adverse cardiovascular cerebrovascular events (MACCE), which included cardiac death, nonfatal myocardial infarction, ischemia-driven target vessel revascularization, all-cause stent thrombosis, and stroke during 6-month follow-up. Results A total 1042 enrolled analyzed (DPI, 522; DAPT, 520). Low-dose non-inferior BARC bleeding [8 (1.5%) 6 (1.2%), absolute difference 0.38%, 95% confidence interval (CI) (− 1.02–1.78), p < 0.0001 non-inferiority]. Abdominal pain significantly lower DPI ( = 0.009). Other abdominal discomforts, MACCE similar. Conclusions PCI, DAPT. Trial registration Chinese Clinical Registry ChiCTR2100044319. Registered on March 16, 2021.