title: Reduction of stent thrombosis in patients with acute coronary syndromes treated with rivaroxaban in ATLAS-ACS 2 TIMI 51.
abstract: OBJECTIVE
  The aim of this study was to determine if rivaroxaban is associated with a reduction in stent thrombosis among patients with acute coronary syndromes (ACS) in the ATLAS-ACS 2 TIMI 51 (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects With Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 51) trial.
  
  
  BACKGROUND
  Dual antiplatelet therapy (DAPT) has been the mainstay of efforts to prevent stent thrombosis. Because thrombin is a potent stimulant of platelet activation, we hypothesized that inhibition of thrombin generation via factor Xa inhibition may further reduce the risk of stent thrombosis.
  
  
  METHODS
  The ATLAS-ACS 2 TIMI 51 study was a placebo-controlled trial that randomly assigned 15,526 patients with recent ACS to receive twice-daily doses of either 2.5 mg or 5 mg of rivaroxaban or placebo for a mean of 13 months and up to 31 months.
  
  
  RESULTS
  Among patients who had a stent placed before or at the time of the index event, rivaroxaban significantly reduced independently adjudicated Academic Research Consortium definite and probable stent thrombosis in the pooled (1.9% vs. 1.5%; hazard ratio [HR]: 0.65; p = 0.017) and the 2.5 mg twice-daily (1.9% vs. 1.5%; HR: 0.61; p = 0.023) treatment groups when compared with placebo, with a trend toward a reduction in the 5 mg twice-daily treatment group (1.9% vs. 1.5%; HR: 0.70; p = 0.089). Among patients who received both aspirin and a thienopyridine (stratum 2), the benefit of rivaroxaban emerged during the period of active treatment with DAPT (HR: 0.68; 95% CI: 0.50 to 0.92, combined rivaroxaban group vs. placebo). Among stented patients who were treated with dual antiplatelet therapy, there was a mortality reduction among those treated with twice-daily rivaroxaban 2.5 mg (HR: 0.56; 95% CI: 0.35 to 0.89; p = 0.014).
  
  
  CONCLUSIONS
  Among stented patients with ACS treated with DAPT, the administration of twice-daily rivaroxaban 2.5 mg was associated with a reduction in stent thrombosis and mortality. (An Efficacy and Safety Study for Rivaroxaban in Patients With Acute Coronary Syndrome; NCT00809965).
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. mgibson@perfuse.org
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Anjan K
authors.initials: AK
authors.lastname: Chakrabarti
authors.forename: Jessica
authors.initials: J
authors.lastname: Mega
authors.forename: Christophe
authors.initials: C
authors.lastname: Bode
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bassand
authors.forename: Freek W A
authors.initials: FW
authors.lastname: Verheugt
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.forename: Marc
authors.initials: M
authors.lastname: Cohen
authors.forename: Satishkumar
authors.initials: S
authors.lastname: Mohanavelu
authors.forename: Paul
authors.initials: P
authors.lastname: Burton
authors.forename: Gregg
authors.initials: G
authors.lastname: Stone
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011725:Pyridines / Q000008:administration & dosage; D000069552:Rivaroxaban; D015607:Stents / Q000009:adverse effects; D013876:Thiophenes / Q000008:administration & dosage*; D013927:Thrombosis / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; D013876:Thiophenes; C446540:thienopyridine; D000069552:Rivaroxaban; D001241:Aspirin
keywords: ACS; DAPT; PCI; acute coronary syndrome(s); dual antiplatelet therapy; factor Xa inhibitor; percutaneous coronary intervention; rivaroxaban; stent thrombosis