A 58-year-old man post-STEMI is started on dual antiplatelet therapy (aspirin + ticagrelor). His cardiologist considers adding low-dose rivaroxaban (2.5 mg twice daily) per the COMPASS trial. This combination is specifically indicated for:
- A Acute STEMI in the first 30 days requiring triple antithrombotic therapy
- B Patients with atrial fibrillation and concurrent ACS
- C High-risk stable atherosclerotic cardiovascular disease — peripheral artery disease or multivessel CAD without recent ACS ✓
- D Non-ST-elevation ACS managed conservatively
Correct answer: C. High-risk stable atherosclerotic cardiovascular disease — peripheral artery disease or multivessel CAD without recent ACS
Explanation
The COMPASS trial demonstrated that rivaroxaban 2.5 mg BD plus aspirin (without a P2Y12 inhibitor) significantly reduced CV death, stroke, and MI in patients with stable atherosclerotic disease (CAD or PAD) compared to aspirin alone. This 'vascular dose' rivaroxaban is indicated for high-risk chronic coronary syndrome or PAD patients, not for acute ACS where triple therapy and different regimens apply. The ATLAS ACS 2 trial evaluated rivaroxaban post-ACS in a different context.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.