{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:48:41Z","timestamp":1753876121243,"version":"3.41.2"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T00:00:00Z","timestamp":1652918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Dual pathway inhibition (DPI) with rivaroxaban 2.5\u2005mg twice daily plus aspirin has demonstrated reductions in major adverse cardiovascular and limb events in eligible patients with chronic coronary artery disease (CAD), peripheral artery disease, or both. Patients with polyvascular disease, heart failure, renal impairment, or diabetes can benefit particularly from this therapy. We present our clinical experience to elucidate practical issues regarding the selection of patients eligible for DPI and the timing of initiation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>The first patient was at high risk of recurrent cardiovascular events due to his history of multi-vessel CAD, myocardial infarction, heart failure, and diabetes. Following a period of post-myocardial infarction dual antiplatelet therapy, he was transitioned to DPI therapy. The second patient was at high risk of cardiovascular events due to his history of polyvascular disease, diffuse CAD, and diabetes. He was hospitalized for unstable angina, which was medically managed because no target lesion was identified. DPI was initiated a day after admission. The third patient was at high risk of cardiovascular events due to an extensive history of polyvascular disease, revascularization, and renal impairment. Although the patient was asymptomatic at routine follow-up, DPI was initiated to reduce the risk of further cardiovascular events.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>In eligible patients who are at high risk of cardiovascular events, DPI therapy with low-dose rivaroxaban should be considered. Treatment can be started at various times, including at the end of dual antiplatelet therapy, at routine follow-up, or after new events or diagnoses.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac201","type":"journal-article","created":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T19:04:11Z","timestamp":1652987051000},"source":"Crossref","is-referenced-by-count":1,"title":["Clinical experience with dual pathway inhibition therapy: case series and mini review"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8864-6038","authenticated-orcid":false,"given":"Tobias","family":"Geisler","sequence":"first","affiliation":[{"name":"Department of Cardiology and Angiology, University Hospital T\u00fcbingen , T\u00fcbingen , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2362-6498","authenticated-orcid":false,"given":"Kelley","family":"Branch","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington , Seattle, WA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sigrid","family":"Nikol","sequence":"additional","affiliation":[{"name":"Department of Clinical and Interventional Angiology, Asklepios Klinik St. Georg , Hamburg , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,5,19]]},"reference":[{"article-title":"Xarelto (rivaroxaban) Summary of Product Characteristics","year":"2021","author":"Bayer","key":"2022071314010736900_ytac201-B1"},{"year":"2021","author":"Janssen Pharmaceuticals Inc. Xarelto (rivaroxaban) Prescribing Information","key":"2022071314010736900_ytac201-B2"},{"key":"2022071314010736900_ytac201-B3","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1056\/NEJMoa1709118","article-title":"Rivaroxaban with or without aspirin in stable cardiovascular disease","volume":"377","author":"Eikelboom","year":"2017","journal-title":"N Engl J Med"},{"key":"2022071314010736900_ytac201-B4","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0140-6736(17)32409-1","article-title":"Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial","volume":"391","author":"Anand","year":"2018","journal-title":"Lancet"},{"key":"2022071314010736900_ytac201-B5","doi-asserted-by":"crossref","first-page":"3271","DOI":"10.1016\/j.jacc.2019.02.079","article-title":"Rivaroxaban plus aspirin versus aspirin in relation to vascular risk in the COMPASS trial","volume":"73","author":"Anand","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2022071314010736900_ytac201-B6","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur Heart J"},{"key":"2022071314010736900_ytac201-B7","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/eurheartj\/ehz486","article-title":"2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD","volume":"41","author":"Cosentino","year":"2020","journal-title":"Eur Heart J"},{"key":"2022071314010736900_ytac201-B8","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1002\/ejhf.1531","article-title":"Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology","volume":"21","author":"Seferovic","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2022071314010736900_ytac201-B9","first-page":"1","article-title":"ESVM guideline on peripheral arterial disease","volume":"48","author":"Frank","year":"2019","journal-title":"Vasa"},{"key":"2022071314010736900_ytac201-B10","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.ejvs.2019.05.006","article-title":"Global vascular guidelines on the management of chronic limb-threatening ischemia","volume":"58","author":"Conte","year":"2019","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2022071314010736900_ytac201-B11","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation","volume":"42","author":"Collet","year":"2021","journal-title":"Eur Heart J"},{"key":"2022071314010736900_ytac201-B12","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1161\/CIRCULATIONAHA.119.039609","article-title":"Rivaroxaban with or without aspirin in patients with heart failure and chronic coronary or peripheral artery disease: the COMPASS trial","volume":"140","author":"Branch","year":"2019","journal-title":"Circulation"},{"key":"2022071314010736900_ytac201-B13","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1161\/CIRCULATIONAHA.120.046448","article-title":"Role of combination antiplatelet and anticoagulation therapy in diabetes and cardiovascular disease: Insights from the COMPASS trial","volume":"141","author":"Bhatt","year":"2020","journal-title":"Circulation"},{"year":"2018","author":"M&A Pharmachem Ltd. Aspirin\u00ae (aspirin) Summary of Product Characteristics","key":"2022071314010736900_ytac201-B14"},{"key":"2022071314010736900_ytac201-B15","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1161\/CIRCULATIONAHA.120.046048","article-title":"The COMPASS trial: net clinical benefit of low-dose rivaroxaban plus aspirin as compared with aspirin in patients with chronic vascular disease","volume":"142","author":"Steffel","year":"2020","journal-title":"Circulation"},{"key":"2022071314010736900_ytac201-B16","doi-asserted-by":"crossref","DOI":"10.1177\/2040620719861475","article-title":"Role of oral anticoagulant therapy for secondary prevention in patients with stable atherothrombotic disease manifestations","volume":"10","author":"Cho","year":"2019","journal-title":"Ther Adv Hematol"},{"key":"2022071314010736900_ytac201-B17","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1161\/CIRCULATIONAHA.120.050749","article-title":"Effect of adding ticagrelor to standard aspirin on saphenous vein graft patency in patients undergoing coronary artery bypass grafting (POPular CABG): a randomized, double-blind, placebo-controlled trial","volume":"142","author":"Willemsen","year":"2020","journal-title":"Circulation"},{"key":"2022071314010736900_ytac201-B18","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.jacc.2018.10.048","article-title":"Rivaroxaban, aspirin, or both to prevent early coronary bypass graft occlusion: the COMPASS-CABG study","volume":"73","author":"Lamy","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2022071314010736900_ytac201-B19","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/eurheartj\/ehx419","article-title":"2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"39","author":"Valgimigli","year":"2018","journal-title":"Eur Heart J"},{"key":"2022071314010736900_ytac201-B20","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1056\/NEJMoa1112277","article-title":"Rivaroxaban in patients with a recent acute coronary syndrome","volume":"366","author":"Mega","year":"2012","journal-title":"N Engl J Med"},{"key":"2022071314010736900_ytac201-B21","doi-asserted-by":"crossref","first-page":"e009451","DOI":"10.1161\/JAHA.118.009451","article-title":"Safety and efficacy of rivaroxaban when added to aspirin monotherapy among stabilized post-acute coronary syndrome patients: A pooled analysis study of ATLAS ACS-TIMI 46 and ATLAS ACS 2-TIMI 51","volume":"8","author":"Gibson","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2022071314010736900_ytac201-B22","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.jacc.2019.11.050","article-title":"Long-term outcomes and associations with major adverse limb events after peripheral artery revascularization","volume":"75","author":"Hess","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2022071314010736900_ytac201-B23","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1056\/NEJMoa2000052","article-title":"Rivaroxaban in peripheral artery disease after revascularization","volume":"382","author":"Bonaca","year":"2020","journal-title":"N Engl J Med"},{"key":"2022071314010736900_ytac201-B24","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1161\/CIRCULATIONAHA.117.032235","article-title":"Low-density lipoprotein cholesterol lowering with evolocumab and outcomes in patients with peripheral artery disease: insights from the FOURIER trial (further cardiovascular outcomes research with PCSK9 inhibition in subjects with elevated risk)","volume":"137","author":"Bonaca","year":"2018","journal-title":"Circulation"},{"key":"2022071314010736900_ytac201-B25","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1161\/CIRCULATIONAHA.119.040167","article-title":"Defining high bleeding risk in patients undergoing percutaneous coronary intervention","volume":"140","author":"Urban","year":"2019","journal-title":"Circulation"},{"key":"2022071314010736900_ytac201-B26","doi-asserted-by":"crossref","first-page":"3743","DOI":"10.1093\/eurheartj\/ehaa671","article-title":"Validation of high bleeding risk criteria and definition as proposed by the academic research consortium for high bleeding risk","volume":"41","author":"Corpataux","year":"2020","journal-title":"Eur Heart J"},{"key":"2022071314010736900_ytac201-B27","doi-asserted-by":"crossref","DOI":"10.1093\/ehjcvp\/pvaa106","article-title":"PRECISE-DAPT score for bleeding risk prediction in patients on dual or single antiplatelet regimens: insights from the GLOBAL LEADERS and GLASSY","author":"Gragnano","year":"2022","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"key":"2022071314010736900_ytac201-B28","doi-asserted-by":"crossref","first-page":"3771","DOI":"10.1093\/eurheartj\/ehz404","article-title":"Estimating individual lifetime benefit and bleeding risk of adding rivaroxaban to aspirin for patients with stable cardiovascular disease: results from the COMPASS trial","volume":"40","author":"de Vries","year":"2019","journal-title":"Eur Heart J"},{"key":"2022071314010736900_ytac201-B29","doi-asserted-by":"crossref","first-page":"n1332","DOI":"10.1136\/bmj.n1332","article-title":"P2Y12 inhibitor monotherapy or dual antiplatelet therapy after coronary revascularisation: individual patient level meta-analysis of randomised controlled trials","volume":"373","author":"Valgimigli","year":"2021","journal-title":"BMJ"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytac201\/43771894\/ytac201.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/7\/ytac201\/44856007\/ytac201.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/7\/ytac201\/44856007\/ytac201.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T14:01:44Z","timestamp":1657720904000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytac201\/6589478"}},"subtitle":[],"editor":[{"given":"Giulio","family":"Russo","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Claudio","family":"Montalto","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Felice","family":"Gragnano","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Edwina","family":"McNaughton","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Mariame","family":"Chakir","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,5,19]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2022,7,6]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytac201","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2022,7,1]]},"published":{"date-parts":[[2022,5,19]]},"article-number":"ytac201"}}