{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:24:55Z","timestamp":1760059495049,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T00:00:00Z","timestamp":1750377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bayer B.V. (Siriusdreef 36, 2132 WT Hoofddorp, The Netherlands)","award":["IMP21459"],"award-info":[{"award-number":["IMP21459"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Despite progress in secondary prevention, people with chronic coronary syndrome (CCS) still face a residual risk of ischemic events. Antithrombotic therapy reduces this risk and helps stabilize chronic cardiovascular disease. Studies have shown that combining low-dose rivaroxaban with aspirin\u2014an approach called dual-pathway inhibition (DPI)\u2014can lower this risk and reduce major adverse cardiovascular events (MACEs). However, researchers have not yet gathered enough real-world data to confirm the efficacy and safety of this strategy. The DUTCH CCS registry aims to collect real-world data on how effective and safe low-dose rivaroxaban combined with aspirin is for patients with CCS in The Netherlands. The study aims to provide insights into the outcomes, benefits, and risks of DPI in a real-world setting, beyond the scope of controlled clinical trials. Methods: The DUTCH CCS registry operates as a national, multicenter, prospective observational study. It enrolls 1000 patients with CCS who receive rivaroxaban (2.5 mg twice daily) and aspirin (80 mg or 100 mg once daily). The study targets individuals at high ischemic risk due to coronary artery disease (CAD) and follows a single-arm design. Researchers will measure the primary efficacy endpoint by tracking MACEs, clinically driven coronary, peripheral, or carotid revascularization, and stent thrombosis over one year. They will assess the primary safety endpoint by recording major bleeding events at one year. The team will collect data at both 3-month and 1-year follow-ups. Conclusions: As an observational study, this registry is not designed to establish causality. However, it seeks to improve our understanding of how DPI performs in real-world secondary prevention for CCS patients. The results may help update treatment guidelines and inform clinical decisions in everyday practice.<\/jats:p>","DOI":"10.3390\/jcm14134401","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T06:50:45Z","timestamp":1750402245000},"page":"4401","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Low-Dose Rivaroxaban in High-Ischemic-Risk Patients with Chronic Coronary Syndrome: Rationale and Design of the DUTCH CCS Registry"],"prefix":"10.3390","volume":"14","author":[{"given":"Abi","family":"Selvarajah","sequence":"first","affiliation":[{"name":"Department of Cardiology, Isala Hospital, 8025 AB Zwolle, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk J.","family":"van der Heijden","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Isala Hospital, 8025 AB Zwolle, The Netherlands"},{"name":"Department of Cardiology, Haaglanden Medical Center, 2512 VA Den Haag, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wouter S.","family":"Remkes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, VieCuri Medical Center, 5912 BL Venlo, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5192-886X","authenticated-orcid":false,"given":"Jurri\u00ebn M.","family":"ten Berg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0581-3532","authenticated-orcid":false,"given":"Michael","family":"Magro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Elisabeth-TweeSteden Hospital, 5022 GC Tilburg, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clemens","family":"von Birgelen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert K.","family":"Riezebos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Isala Hospital, 8025 AB Zwolle, The Netherlands"},{"name":"Department of Cardiology, OLVG Hospital, 1091 AC Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Pisters","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rijnstate Arnhem Hospital, 6815 AD Arnhem, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2373-9858","authenticated-orcid":false,"given":"Martin E. W.","family":"Hemels","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rijnstate Arnhem Hospital, 6815 AD Arnhem, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saman","family":"Rasoul","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zuyderland Medisch Centrum, 6419 PC Heerlen, The Netherlands"},{"name":"Department of Cardiology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnoud W. J.","family":"van \u2018t Hof","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zuyderland Medisch Centrum, 6419 PC Heerlen, The Netherlands"},{"name":"Department of Cardiology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), 6229 HX Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samer","family":"Somi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Haga Hospital, 2545 CH Den Haag, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jawed","family":"Polad","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jeroen Bosch Hospital, 5223 GZ Den Bosch, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pieter","family":"Hoogslag","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Isala Hospital, 8025 AB Zwolle, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renicus S.","family":"Hermanides","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Isala Hospital, 8025 AB Zwolle, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1016\/S0140-6736(09)60503-1","article-title":"Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomised trials","volume":"373","author":"Baigent","year":"2009","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1056\/NEJMoa2102137","article-title":"Comparative effectiveness of aspirin dosing in cardiovascular disease","volume":"384","author":"Jones","year":"2021","journal-title":"N. 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