Rivaroxaban and Aspirin Combination Therapy

Primary Indication: Atrial Fibrillation with PCI

• The American College of Cardiology recommends rivaroxaban 15mg once daily plus a P2Y12 inhibitor as an alternative to triple therapy for patients with nonvalvular atrial fibrillation undergoing PCI, with a reduced risk of clinically significant bleeding 1, 3
• The combination of rivaroxaban 15mg daily and aspirin 81mg daily is indicated for patients with atrial fibrillation who have undergone PCI with stenting, to balance stroke prevention and bleeding risk 1, 2
• The regimen should be used for 12 months post-PCI in most patients, and then transition to oral anticoagulation alone 1, 2

Dosing Considerations

• For patients with moderate renal impairment (CrCl 30-50 mL/min), the dose of rivaroxaban should be reduced to 15mg daily for AF patients 5, 4
• The standard dose of rivaroxaban for AF stroke prevention is 20mg daily, but 15mg daily is used when combined with antiplatelet agents 6, 5

Bleeding Risk Management

• The European Heart Journal recommends routine proton pump inhibitor use to reduce the risk of gastrointestinal bleeding 8, 3
• The American College of Cardiology advises avoiding NSAIDs and other antiplatelet agents beyond the prescribed regimen to minimize bleeding risk 9

Contraindications and Precautions

• The American College of Cardiology states that valvular atrial fibrillation is an absolute contraindication for this combination, and warfarin is required instead 7
• The European Heart Journal notes that severe hepatic impairment is a contraindication for rivaroxaban 8

Monitoring Requirements

• The American College of Cardiology recommends assessing renal function at baseline and annually, and evaluating for signs of bleeding at each visit 4