What is the role of rivaroxaban in the treatment of acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Use of the oral Xa inhibitor rivaroxaban in patients with ACS was investigated in the ATLAS ACS 2-TIMI 51 trial. [95, 96] Cutting the rivaroxaban dosage from 5 mg twice daily to 2.5 mg twice daily reduced deaths and bleeding after ACS. Mortality from recurrent events was significantly lower with the 2.5-mg dose (30.6% vs 43.8%), as was the death rate from new MI (8.8% vs 17.2%). The risk of fatal bleeding was 61% lower with the 2.5-mg dose, and rates of TIMI bleeding requiring medical attention were significantly lower (12.9% vs 16.2%).


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