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In patients with prior coronary artery disease or peripheral arterial disease the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial revealed that compared with acetylsalicylic acid alone, dual pathway inhibition with low-dose rivaroxaban (2.5 mg twice-daily), an oral factor Xa inhibitor, plus acetylsalicylic acid reduced major adverse cardiovascular event by 24%, major adverse limb events by 47%, and mortality by 18%. Major bleeding was increased by 70%, but there was no increase in fatal or intracranial bleeding. This article (1) reviews the results of the COMPASS trial, (2) explains why dual pathway inhibition is superior to antiplatelet or anticoagulant therapy alone, (3) compares the results with rivaroxaban plus aspirin with those with other antithrombotic regimens, and (4) provides insight into how best to apply the COMPASS results into practice.<\/jats:p>","DOI":"10.1161\/circresaha.118.313141","type":"journal-article","created":{"date-parts":[[2019,1,31]],"date-time":"2019-01-31T19:00:19Z","timestamp":1548961219000},"page":"416-425","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Synergy of Dual Pathway Inhibition in Chronic Cardiovascular Disease"],"prefix":"10.1161","volume":"124","author":[{"given":"Michiel","family":"Coppens","sequence":"first","affiliation":[{"name":"From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, location AMC, the Netherlands 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