ELIGIBILITY FOR ASPIRIN PLUS LOW-DOSE RIVAROXABAN AMONG CARDIOLOGY OUTPATIENTS IN AN ACADEMIC TERTIARY CARE CENTER

Abstract

<h3>BACKGROUND</h3> The addition of low-dose rivaroxaban to aspirin in patients with stable atherosclerotic disease has been shown effective in reducing ischemic events. However, what proportion of cardiology patients might be deemed eligible for such therapy remains uncertain. We aimed to estimate the rate of eligibility among cardiology outpatients at an academic tertiary care center. <h3>METHODS AND RESULTS</h3> We retrospectively reviewed the antithrombotic treatment of all patients presenting to the cardiology clinic in an academic tertiary care center between January 1st to February 28th, 2019. Among patients with atherosclerotic disease, but without an indication for anticoagulation, we assessed the extent of atherosclerosis, recent ischemic events (myocardial infarction or cerebral vascular accident), ischemic risk factors (smoking, diabetes, dyslipidemia, history of stroke) and their eligibility for aspirin and low dose rivaroxaban combination therapy based on the inclusion criteria of the COMPASS trial. A total of 2503 unique patients consulted at the cardiology clinic during the period of study. Of these, 1172 patients (46.8%) had a diagnosis of atherosclerotic vascular disease, of whom 286 (24.4%) already received anticoagulation (TABLE). Among those without an indication for anticoagulation, 59 (6.7%) had no documented antithrombotic therapy, 616 (69.5%) patients were on ASA alone, and 46 (5.2%) were on P2Y12-inhibitor monotherapy. Of note, the coexistence of coronary and peripheral artery disease (often a criterion for formulary reimbursement) was documented in only 115 (13.0%) vascular disease patients without an indication for anticoagulation. <h3>CONCLUSION</h3> While a large proportion of cardiology outpatients could potentially benefit from the combination of ASA and low-dose rivaroxaban, the coexistence of coronary and peripheral vascular disease might be underdiagnosed. A combination of educational initiatives and targeted interventions might improve the identification of eligible patients and lead to better cardiovascular outcomes. Furthermore, given the bleeding risk associated with this drug combination, a shared decision making would also likely improve the quality of care.