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Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial
Open accessAbstract
Background Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.Methods This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.Findings Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).Interpretation Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding.Funding Bayer AG.
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“A study shared that low-dose rivaroxaban with aspirin reduced major adverse cardiovascular and limb events compared with aspirin alone without significantly increasing major bleeding [82].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [82]
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“There was an associated increased risk of bleeding with rivaroxaban, although no significant excess in fatal bleeding was noted.”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [58]
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“a review of 56 studies including patients with diabetes suggested higher limbsalvage rates after revascularization (78-85% at 1 year) compared with conservative management.768”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [768]
In the citing paper
“The risk of major adverse cardiovascular events (MACEs) was significantly lower with the combination of rivaroxaban plus aspirin compared with either aspirin alone or rivaroxaban alone.”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [58]
In the citing paper
“The ischemic benefits of rivaroxaban were consistent in the subgroup with diabetes mellitus, suggesting that low-dose anticoagulation added to antiplatelet therapy may be another option for secondary prevention in patients with T2DM and stable CAD.”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [58]
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Antiplatelet Therapy in Atherothrombotic Diseases: Similarities and Differences Across Guidelines
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“5 mg twice-daily to aspirin 100 mg once daily could be suitable in adult patients with symptomatic PAD at high risk of ischemic events without high bleeding risk as for instance in some DM patients (ESC: COR IIa, LOE B) (Anand et al., 2018; Cosentino et al., 2020).”
BackgroundEscobar-Cervantes, C., Reino, A. P., Díez‐Villanueva, P., Fácila, L., Freixa‐Pamias, R., Valle, A., Almendro‐Delia, M., Bonanad, C., Vivas, D., & Suárez, C. (2023) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2023.2272652 · Cited by 6
“…combination of aspirin and low-dose rivaroxaban consistently reduced the risk of the composite endpoint of cardiovascular death, myocardial infarction, or stroke by 28% (HR 0.72; 95% CI 0.57–0.90) and major adverse limb events, including major amputation, by 46% (HR 0.54; 95% CI 0.35–0.82) [90].”
BackgroundInfluentialCantú-Brito, C. G., Chiquete, E., Antezana-Castro, J., Toapanta-Yanchapaxi, L. N., Ochoa-Guzmán, A., Ruíz‐Sandoval, J. L., & INDAGA Cardiologists Investigators (2020) · Vascular · doi:10.1177/1708538120938921 · Cited by 6
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“Large trials in this population will inform additional therapies to reduce CV risk and limb events.(11) QI programs are vital to help identify treatment gaps and introduce opportunities to strive for best clinical practice, which is critical to improve outcomes among high-risk patients.”
BackgroundWang, P., Chen, T., Chung, C., Chen, M., Chang, J.-J., Lin, Y., Chu, P., Peng, Y., & Lin, M. (2021) · Scientific Reports · doi:10.1038/s41598-021-87461-y · Cited by 6
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“5 mg twice daily of rivaroxaban or 100 mg daily of aspirin has been shown to reduce the incidence of cardiovascular disease-caused death, stroke, or myocardial infarction by 24%, while increasing the occurrence of adverse effects, such as hemorrhage (10-12).”
BackgroundAdvances in atherosclerosis, atrial fibrillation, and valvular disease
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“This finding has opened the field for new studies to determine the underlying mechanism of these strokes, including the complications of atherothrombotic disease in sinus rhythm [113,114,135].”
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“ESC guidelines on peripheral artery disease in 2017 recommended in patients with lower extremity artery disease and atrial fibrillation, oral anticoagulation should be given with a CHA2DS2-VASc score >2 (I).16 Rivaroxaban, as a new oral anticoagulant inhibiting factor Xa, is getting more and more attention in patients…”
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“Over the 12-year period, 2550 patients underwent percutaneous or surgical intervention for PAD.”
ResultInfluentialPrecision Monitoring of Antithrombotic Therapy in Cardiovascular Disease
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“Evidence that administration of low-dose rivaroxaban reduces the rate of major adverse cardiovascular events in patients with stable atherosclerotic disease [123] further highlights the importance of continuing to target thrombosis within the context of atherosclerotic disease.”
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“Currently, there is limited data to precisely guide antiplatelet and anticoagulation management [38] Recent research suggests that low-dose rivaroxaban is more effective than aspirin alone in preventing significant adverse cardiovascular and limb events [39].”
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“31, p = 0 · 0089), which was mainly gastrointestinal [42].”
BackgroundTackling Elevated Risk in PAD: Focus on Antithrombotic and Lipid Therapy for PAD
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“number of interventional studies has consistently reported that the modification of potential risk factors [33] and the administration of beta-adrenergicblocking agents [34] and aspirin [35] reduce the risk of adverse cardiovascular events after incident CVD.”
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“However, the effects of the combination of rivaroxaban and aspirin on IC have not been evaluated.(7) The benefits of the combination of rivaroxaban and aspirin compared with aspirin alone in preventing MALE in patients with PAD are believed to be due to the prevention of recurrent thromboembolism, which can cause dist…”
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“In den letzten Jahren wurden 2 große randomisierte Studien zur Kombination von Acetylsalicylsäure (ASS) und Rivaroxaban in niedriger Dosis („vaskuläre Dosis“, 2 × 2,5 mg) publiziert [3, 4, 5].”
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“The subanalyses of the COMPASS (Cardiovascular OutcoMes for people using Anticoagulation StrategieS) trial (17,18) revealed that the success of anticoagulants was predominantly driven by atheroembolicbased diseases than coronary artery disease itself.”
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Antithrombotika und Antihämorrhagika
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Zhu, H., Xu, X., Wang, H., Chen, Q., Fang, X., Zheng, J., Gao, B., Tong, G., Zhou, L., Chen, T., et al. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.1040473 · Cited by 5
Enea, I., & Martelli, E. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12113652 · Cited by 5
Armengol, G., Goudot, G., Miranda, S., Benhamou, Y., Tafflet, M., Guillet, H., Mortelette, H., Levesque, H., Messas, E., & Mirault, T. (2023) · Angiology · doi:10.1177/00033197231218332 · Cited by 4
Self-citationWelsh, R. C., Gouda, P., Dover, D., Bainey, K. R., McAlister, F. A., & Kaul, P. (2024) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2024.117486 · Cited by 4
Self-citationSaadi, S. M., Nayfeh, T., Rajjoub, R., Hasan, B., Firwana, M., Jawaid, T., Hazem, W., Shah, S. H., Alsawaf, Y., Seisa, M. O., et al. (2025) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2024.12.135 · Cited by 4
Diretriz de Síndrome Coronariana Crônica – 2025
César, L. A. M., Gowdak, L. H. W., Pavanello, R., Ferreira, J. F. M., Mioto, B. M., Poppi, N. T., Mendonça, C. J. L., Beck, A. L. D. S., de Brito, A. S. X., Abizaid, A., et al. (2025) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20250619 · Cited by 14
The year in cardiology 2017: prevention
Nordestgaard, B. G., Cosentino, F., Landmesser, U., & Laufs, U. (2017) · European Heart Journal · doi:10.1093/eurheartj/ehx766 · Cited by 4
Mant, J. (2018) · BMJ Evidence-Based Medicine · doi:10.1136/bmjebm-2018-110899 · Cited by 4
Optimizing medical management in peripheral artery disease
Coughlin, P. A., & Rudd, J. H. F. (2018) · British journal of surgery · doi:10.1002/bjs.10883 · Cited by 4
Kawarada, O., Nakai, M., Nishimura, K., Miwa, H., Iwasaki, Y., Kanno, D., Nakama, T., Yamamoto, Y., Ogata, N., Nakamura, M., et al. (2019) · Heart Asia · doi:10.1136/heartasia-2018-011114 · Cited by 4
Krasiński, Z., Gaciong, Z. A., Szymański, F. M., Kowalewski, R., & Urbanek, T. (2019) · Acta Angiologica · doi:10.5603/aa.2019.0007 · Cited by 4
“In the prospectively planned analysis of a subgroup of 7,470 patients with PAD (LEAD or carotid artery disease) it was determined that the combined treatment with ASA and rivaroxaban significantly reduced the incidence of the aforementioned composite endpoint, as compared to ASA alone (reduction of risk by 28%), and s…”
ResultVerma, S., Eikelboom, J. W., Al-Omran, M. A., Choi, R., Heffernan, M., Teoh, H., & Bhatt, D. L. (2020) · Med · doi:10.1016/j.medj.2020.05.003 · Cited by 4
Self-citationMedical optimization of the peripheral artery disease patient
Dittman, J. M., Amendola, M. F., & Lavingia, K. S. (2022) · Seminars in Vascular Surgery · doi:10.1053/j.semvascsurg.2022.04.003 · Cited by 4
Balletshofer, B. M., Böckler, D., Diener, H., Heckenkamp, J., Ito, W. D., Katoh, M., Lawall, H., Malyar, N. M., Oberländer, Y., Reimer, P., et al. (2022) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1624-3631 · Cited by 6
“In patients with PAD, blood pressure < 120 mmHg and > 160 mmHg result in more leg events [15].”
BackgroundGao, F., & Rahman, F. (2022) · Current Atherosclerosis Reports · doi:10.1007/s11883-022-01022-w · Cited by 4
Zeymer, U., Schrage, B., & Westermann, D. (2018) · Thrombosis and Haemostasis · doi:10.1055/s-0038-1668133 · Cited by 4
Periphere arterielle Verschlusskrankheit als Prädiktor einer hohen Atheroskleroselast
Espinola–Klein, C., Vosseler, M., Abegunewardene, N., Himmrich, L., Schlosser, A., & Schuster, C. J. (2019) · Herz · doi:10.1007/s00059-018-4774-3 · Cited by 4
“Es kam in der Kombinationstherapie allerdings zu einem erhöhten Risiko für nicht zerebrale „Major“-Blutungen [22].”
BackgroundDornquast, C., Dombrowski, M., Zabel, M., Willich, S. N., & Reinhold, T. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05131-7 · Cited by 4
Krumb, E., & Hermans, C. R. J. R. (2021) · Research and Practice in Thrombosis and Haemostasis · doi:10.1002/rth2.12479 · Cited by 3
Watson, K. (2017) · The American Pharmacists Association eBooks · doi:10.21019/pharmacotherapyfirst.pad_overview · Cited by 4
Low-dose rivaroxaban: can cardiovascular events be reduced?
Luca, L. D. (2023) · European Heart Journal Supplements · doi:10.1093/eurheartjsupp/suad034 · Cited by 4
“The rationale that can explain the improvement of cardiovascular outcome is that platelet aggregation and fibrin formation are involved in arterial thrombosis and rivaroxaban is able to target both ways and has a synergic effect with ASA.”
BackgroundResultInfluentialKomarov, A. L., Novikova, Е. S., Guskova, E. V., Yarovaya, E. B., An, S., & Панченко, Е. П. (2018) · Rational Pharmacotherapy in Cardiology · doi:10.20996/1819-6446-2018-14-2-272-283 · Cited by 5
Anticoagulation in Peripheral Artery Disease: Are We There Yet?
Cannavale, A., Santoni, M., Cannavale, G., & Fanelli, F. (2020) · Vascular and Endovascular Review · doi:10.15420/ver.2019.10 · Cited by 4
“One of the earlier trials was the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial which assessed the efficacy of rivaroxaban ± aspirin versus aspirin alone.(16) The trial enrolled 27,395 patients at 602 centres worldwide with stable atherosclerotic vascular disease (CAD, PAD or both…”
Rivaroxaban in peripheral artery disease: The new kid on the block?
Hussain, M. A., Verma, S., & Al-Omran, M. A. (2018) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2018.01.019 · Cited by 4
Introduction to the Vascular Medicine Issue of Progress in Cardiovascular Diseases
Kim, E., & Beckman, J. A. (2018) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2018.04.003 · Cited by 3
Peripheral Artery Disease Centres of Excellence in Canada—Call to Action
Wan, D., Virani, S., Abramson, B. L., McMurtry, M. S., Kaplovitch, E., Roussin, A., & Anand, S. S. (2025) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2025.01.019 · Cited by 3
Self-citationNontraditional Risk Factors for Peripheral Artery Disease: Setting the Scene
Allison, M., Powell, J. T., & Golledge, J. (2025) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.125.323193 · Cited by 3
MicroRNA-223-3p is a determinant of platelet procoagulant activity
Charlon-Gay, J., Nolli, S., Dunoyer-Geindre, S., Ciepla, P., Reny, J., & Fontana, P. (2025) · Blood Advances · doi:10.1182/bloodadvances.2024015290 · Cited by 4
“51,52 However, this strategy is associated with an increase in major bleeding, 53,54 and we speculate that the proportion of procoagulant platelets modulates the risk of bleeding events in low-dose anticoagulation.”
Optimizing selection of P2Y 12 inhibiting therapy: clopidogrel, prasugrel or ticagrelor
Galli, M., Simeone, B., Gragnano, F., D’Amario, D., Sarto, G., Frati, G., Greco, E., Calabrò, P., Sciarretta, S., Mehran, R., et al. (2025) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2025.2576607 · Cited by 3
Systematic review of Chinese medicine for the treatment of atherosclerosis
Tang, C., Liu, B., Zhang, Y., Long, M., Zheng, W., Lü, J., Han, L., Xu, Z., & Wang, Y. (2025) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2025.1671008 · Cited by 3
Self-citationThe internal medicine management of diabetic foot syndrome
Miranda, C., & ROS, R. D. (2025) · Minerva Medica · doi:10.23736/s0026-4806.25.09805-2 · Cited by 3
2026 ACC/AHA Clinical Performance and Quality Measures for Patients With Peripheral Artery Disease
Goodney, P. P., Ross, E., Bruckel, J. T., Alabi, O., Altin, S. E., Bauer, K. L., Diekemper, R. L., Gerhard‐Herman, M. D., Johnston, L. E., Martin, V. T., et al. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2025.09.003 · Cited by 4
Current and emerging approaches to managing peripheral artery disease: a specialist review
Mohammadi, A., Hussein, L., Yahyavi, A., & Shishehbor, M. H. (2026) · Heart · doi:10.1136/heartjnl-2025-326532 · Cited by 3
Kamran, H., Malhotra, R., Farhan, S., Masoomi, R., Garg, A., Hooda, A., Lascano, R. A., Han, D. K., Tadros, R. O., Tarricone, A. N., et al. (2021) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2021.02.033 · Cited by 3
Patti, G., Fattirolli, F., Luca, L. D., Renda, G., Marcucci, R., Parodi, G., Perna, G. P., Andreotti, F., Ghiglieno, C., Fedele, F., et al. (2021) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2021.111783 · Cited by 3
Self-citationNo benefit of vorapaxar on walking performance in patients with intermittent claudication
Tsai, S., Liu, Y., Alaiti, M. A., Gutierrez, J. A., Brilakis, E. S., & Banerjee, S. (2021) · Vascular Medicine · doi:10.1177/1358863x211042082 · Cited by 3
Self-citationMeuli, L., Stadlbauer, T. H. W., Stähli, B. E., Espinola–Klein, C., Zimmermann, A., & Collaborators, O. B. O. T. P. S. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12093223 · Cited by 3
Baretella, O., Buser, L., Andres, C., Häberli, D., Lenz, A., Döring, Y., Baumgärtner, I., & Schindewolf, M. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1004003 · Cited by 4
Huo, S., & Cheng, J. S. (2023) · Frontiers in Surgery · doi:10.3389/fsurg.2023.1285553 · Cited by 3
Sunner, S. S., Welsh, R. C., & Bainey, K. R. (2023) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2023.11.028 · Cited by 3
Self-citationStrategies to reduce out-of-pocket medication costs for Canadians with peripheral arterial disease
McClure, G. R., McIntyre, W. F., Belesiotis, P., Kaplovitch, E., Chan, N., Bhagirath, V. C., Chahil, G., Hayes, A., Sohi, G. K., Bordman, W., et al. (2024) · Canadian Journal of Surgery · doi:10.1503/cjs.003722 · Cited by 4
Self-citation
Metadata
- Authors
- Anand, S. S., Bosch, J., Eikelboom, J. W., Connolly, S. J., Diaz, R., Widimsky, P., Aboyans, V., Alings, M., Kakkar, A. K., Keltai, K., Maggioni, A. P., Lewis, B. S., Störk, S., Zhu, J., Lopez-Jaramillo, P., O'Donnell, M., Commerford, P. J., Vinereanu, D., Pogosova, N., Ryden, L., Fox, K. A. A., Bhatt, D. L., Misselwitz, F., Varigos, J. D., Vanassche, T., Avezum, A. A., Chen, E., Branch, K., Leong, D. P., Bangdiwala, S. I., Hart, R. G., Yusuf, S., SALA, J., CARTASEGNA, L., VICO, M., HOMINAL, M. A., HASBANI, E., CACCAVO, A., ZAIDMAN, C., VOGEL, D., HRABAR, A., SCHYGIEL, P. O., CUNEO, C., LUQUEZ, H., MACKINNON, I. J., AHUAD GUERRERO, R. A., COSTABEL, J. P., BARTOLACCI, I. P., MONTANA, O., BARBIERI, M., GOMEZ VILAMAJO, O., GARCIA DURAN, R. O., SCHIAVI, L. B., GARRIDO, M., INGARAMO, A., BORDONAVA, A. P., PELAGAGGE, M. J., NOVARETTO, L., ALBISU DI GENNERO, J. P., IBANEZ SAGGIA, L. M., ALVAREZ, M., VITA, N. A., MACIN, S. M., DRAN, R. D., CARDONA, M., GUZMAN, L., SARJANOVICH, R. J., CUADRADO, J., NANI, S., LITVAK BRUNO, M. R., CHACON, C., MAFFEI, L. E., GRINFELD, D., VENSENTINI, N., MAJUL, C. R., LUCIARDI, H. L., GONZALEZ COLASO, P. D. C., FERRE PACORA, F. A., VAN DEN HEUVEL, P., VERHAMME, P., ECTOR, B., DEBONNAIRE, P., VAN DE BORNE, P., LEROY, J., SCHROE, H., VRANCKX, P., ELEGEERT, I., HOFFER, E., DUJARDIN, K., INDIO DO BRASIL, C., PRECOMA, D., ABRANTES, J. A., MANENTI, E., REIS, G., SARAIVA, J., MAIA, L., HERNANDES, M., ROSSI, P., ROSSI DOS SANTOS, F., ZIMMERMANN, S. L., RECH, R., ABIB JR, E., LEAES, P., BOTELHO, R., DUTRA, O., SOUZA, W., BRAILE, M., IZUKAWA, N., NICOLAU, J. C., TANAJURA, L. F., SERRANO JUNIOR, C. V., MINELLI, C., NASI, L. A., OLIVEIRA, L., DE CARVALHO CANTARELLI, M. J., TYTUS, R., PANDEY, S., LONN, E., CHA, J., VIZEL, S., BABAPULLE, M., LAMY, A., SAUNDERS, K., BERLINGIERI, J., KIAII, B., BHARGAVA, R., MEHTA, P., HILL, L., FELL, D., LAM, A., AL-QOOFI, F., BROWN, C., PETRELLA, R., RICCI, J. A., GLANZ, A., NOISEUX, N., BAINEY, K., MERALI, F., HEFFERNAN, M., DELLA SIEGA, A., DAGENAIS, G. R., DAGENAIS, F., BRULOTTE, S., NGUYEN, M., HARTLEIB, M., GUZMAN, R., BOURGEOIS, R., RUPKA, D., KHAYKIN, Y., GOSSELIN, G., HUYNH, T., PILON, C., CAMPEAU, J., PICHETTE, F., DIAZ, A., JOHNSTON, J., SHUKLE, P., HIRSCH, G., RHEAULT, P., CZARNECKI, W., ROY, A., NAWAZ, S., FREMES, S., SHUKLA, D., JANO, G., COBOS, J. L., CORBALAN, R., MEDINA, M., NAHUELPAN, L., RAFFO, C., PEREZ, L., POTTHOFF, S., STOCKINS, B., SEPULVEDA, P., PINCETTI, C., VEJAR, M., TIAN, H., WU, X., KE, Y., JIA, K., YIN, P., WANG, Z., YU, L., WU, S., WU, Z., LIU, S. W., BAI, X. J., ZHENG, Y., YANG, P., YANG, Y. M., ZHANG, J., GE, J., CHEN, X. P., LI, J., HU, T. H., ZHANG, R., ZHENG, Z., CHEN, X., TAO, L., LI, J., HUANG, W., FU, G., LI, C., DONG, Y., WANG, C., ZHOU, X., KONG, Y., SOTOMAYOR, A., ACCINI MENDOZA, J. L., CASTILLO, H., URINA, M., AROCA, G., PEREZ, M., MOLINA DE SALAZAR, D. I., SANCHEZ VALLEJO, G., FERNANDO, M. J., GARCIA, H., GARCIA, L. H., ARCOS, E., GOMEZ, J., CUERVO MILLAN, F., TRUJILLO DADA, F. A., VESGA, B., MORENO SILGADO, G. A., ZIDKOVA, E., LUBANDA, J.-C., KALETOVA, M., KRYZA, R., MARCINEK, G., RICHTER, M., SPINAR, J., MATUSKA, J., TESAK, M., MOTOVSKA, Z., BRANNY, M., MALY, J., MALY, M., WIENDL, M., FOLTYNOVA CAISOVA, L., SLABY, J., VOJTISEK, P., PIRK, J., SPINAROVA, L., BENESOVA, M., CANADYOVA, J., HOMZA, M., FLORIAN, J., POLASEK, R., COUFAL, Z., SKALNIKOVA, V., BRAT, R., BRTKO, M., JANSKY, P., LINDNER, J., MARCIAN, P., STRAKA, Z., TRETINA, M., DUARTE, Y. C., POW CHON LONG, F., SANCHEZ, M., LOPEZ, J., PERUGACHI, C., MARMOL, R., TRUJILLO, F., TERAN, P., TUOMILEHTO, J., TUOMILEHTO, H., TUOMINEN, M.-L., TUOMILEHTO, H., KANTOLA, I., STEG, G., ABOYANS, V., LECLERCQ, F., FERRARI, E., BOCCARA, F., MESSAS, E., MISMETTI, P., SEVESTRE, M. A., CAYLA, G., MOTREFF, P., STOERK, S., DUENGEN, H.-D., STELLBRINK, C., GUEROCAK, O., KADEL, C., BRAUN-DULLAEUS, R., JESERICH, M., OPITZ, C., VOEHRINGER, H.-F., APPEL, K.-F., WINKELMANN, B., DORSEL, T., NIKOL, S., DARIUS, H., RANFT, J., SCHELLONG, S., JUNGMAIR, W., DAVIERWALA, P., VORPAHL, M., BAJNOK, L., LASZLO, Z., NOORI, E., VERESS, G., VERTES, A., ZSARY, A., KIS, E., KORANYI, L., BAKAI, J., BODA, Z., POOR, F., JARAI, Z., KEMENY, V., BARTON, J., MCADAM, B., MURPHY, A., CREAN, P., MAHON, N., CURTIN, R., MACNEILL, B., DINNEEN, S., HALABI, M., ZIMLICHMAN, R., ZELTSER, D., TURGEMAN, Y., KLAINMAN, E., LEWIS, B., KATZ, A., ATAR, S., ZIMLICHMAN, R., NIKOLSKY, E., BOSI, S., NALDI, M., FAGGIANO, P., ROBBA, D., MOS, L., SINAGRA, G., COSMI, F., OLTRONA VISCONTI, L., CARMINE, D. M., DI PASQUALE, G., DI BIASE, M., MANDORLA, S., BERNARDINANGELI, M., PICCINNI, G. C., GULIZIA, M. M., GALVANI, M., VENTURI, F., MOROCUTTI, G., BALDIN, M. G., OLIVIERI, C., PERNA, G. P., CIRRINCIONE, V., KANNO, T., DAIDA, H., OZAKI, Y., MIYAMOTO, N., HIGASHIUE, S., DOMAE, H., HOSOKAWA, S., KOBAYASHI, H., KURAMOCHI, T., FUJII, K., MIZUTOMI, K., SAKU, K., KIMURA, K., HIGUCHI, Y., ABE, M., OKUDA, H., NODA, T., MITA, T., HIRAYAMA, A., ONAKA, H., INOKO, M., HIROKAMI, M., OKUBO, M., AKATSUKA, Y., IMAMAKI, M., KAMIYA, H., MANITA, M., HIMI, T., UENO, H., HISAMATSU, Y., AKO, J., NISHINO, Y., KAWAKAMI, H., YAMADA, Y., KORETSUNE, Y., YAMADA, T., YOSHIDA, T., SHIMOMURA, H., KINOSHITA, N., TAKAHASHI, A., YUSOFF, K., WAN AHMAD, W. A., ABU HASSAN, M. R., KASIM, S., ABDUL RAHIM, A. A., MOHD ZAMRIN, D., MACHIDA, M., HIGASHINO, Y., UTSU, N., NAKANO, A., NAKAMURA, S., HASHIMOTO, T., ANDO, K., SAKAMOTO, T., PRINS, F. J., LOK, D., MILHOUS, J. G.-J., VIERGEVER, E., WILLEMS, F., SWART, H., ALINGS, M., BREEDVELD, R., DE VRIES, K.-J., VAN DER BORGH, R., OEI, F., ZOET-NUGTEREN, S., KRAGTEN, H., HERRMAN, J. P., VAN BERGEN, P., GOSSELINK, M., HOEKSTRA, E., ZEGERS, E., RONNER, E., DEN HARTOG, F., BARTELS, G., NIEROP, P., VAN DER ZWAAN, C., VAN ECK, J., VAN GORSELEN, E., GROENEMEIJER, B., HOOGSLAG, P., DE GROOT, M. R., LOYOLA, A., SULIT, D. J., REY, N., ABOLA, M. T., MORALES, D., PALOMARES, E., ABAT, M. E., ROGELIO, G., CHUA, P., DEL PILAR, J. C., ALCARAZ, J. D., EBO, G., TIRADOR, L., CRUZ, J., ANONUEVO, J., PITARGUE, A., JANION, M., GUZIK, T., GAJOS, G., ZABOWKA, M., RYNKIEWICZ, A., BRONCEL, M., SZUBA, A., CZARNECKA, D., MAGA, P., STRAZHESKO, I., VASYUK, Y., SIZOVA, Z., POZDNYAKOV, Y., BARBARASH, O., VOEVODA, M., POPONINA, T., REPIN, A., OSIPOVA, I., EFREMUSHKINA, A., NOVIKOVA, N., AVERKOV, O., ZATEYSHCHIKOV, D., VERTKIN, A., AUSHEVA, A., COMMERFORD, P., SEEDAT, S., VAN ZYL, L., ENGELBRECHT, J., MAKOTOKO, E. M., PRETORIUS, C. E., MOHAMED, Z., HORAK, A., MABIN, T., KLUG, E., BAE, J.-H., KIM, C., KIM, C.-J., KIM, D.-S., KIM, Y. J., JOO, S., HA, J.-W., PARK, C. S., KIM, J. Y., KIM, Y.-K., JARNERT, C., MOOE, T., DELLBORG, M., TORSTENSSON, I., ALBERTSSON, P., JOHANSSON, L., AL-KHALILI, F., ALMROTH, H., ANDERSSON, T., PANTEV, E., TENGMARK, B.-O., LIU, B., RASMANIS, G., WAHLGREN, C.-M., MOCCETTI, T., PARKHOMENKO, A., TSELUYKO, V., VOLKOV, V., KOVAL, O., KONONENKO, L., PROKHOROV, O., VDOVYCHENKO, V., BAZYLEVYCH, A., RUDENKO, L., VIZIR, V., KARPENKO, O., MALYNOVSKY, Y., KOVAL, V., STOROZHUK, B., COTTON, J., VENKATARAMAN, A., MORIARTY, A., CONNOLLY, D., DAVEY, P., SENIOR, R., BIRDI, I., CALVERT, J., DONNELLY, P., TREVELYAN, J., CARTER, J., PEACE, A., AUSTIN, D., KUKREJA, N., HILTON, T., SRIVASTAVA, S., WALSH, R., FIELDS, R., HAKAS, J., PORTNAY, E., GOGIA, H., SALACATA, A., HUNTER, J. J., BACHARACH, J. M., SHAMMAS, N., SURESH, D., SCHNEIDER, R., GURBEL, P., BANERJEE, S., GRENA, P., BEDWELL, N., SLOAN, S., LUPOVITCH, S., SONI, A., GIBSON, K., SANGRIGOLI, R., MEHTA, R., I-HSUAN TSAI, P., GILLESPIE, E., DEMPSEY, S., HAMROFF, G., BLACK, R., LADER, E., KOSTIS, J. B., BITTNER, V., MCGUINN, W., BRANCH, K., MALHOTRA, V., MICHAELSON, S., VACANTE, M., MCCORMICK, M., ARIMIE, R., CAMP, A., DAGHER, G., KOSHY, N. M., THEW, S., COSTELLO, F., HEIMAN, M., CHILTON, R., MORAN, M., ADLER, F., COMEROTA, A., SEIWERT, A., FRENCH, W., SEROTA, H., HARRISON, R., BAKAEEN, F., OMER, S., CHANDRA, L., WHELAN, A., BOYLE, A., ROBERTS-THOMSON, P., ROGERS, J., CARROLL, P., COLQUHOUN, D., SHAW, J., BLOMBERY, P., AMERENA, J., HII, C., ROYSE, A., SINGH, B., SELVANAYAGAM, J., JANSEN, S., LO, W., HAMMETT, C., POULTER, R., NARASIMHAN, S., WIGGERS, H., NIELSEN, H., GISLASON, G., KOBER, L., HOULIND, K., BOENELYKKE SOERENSEN, V., DIXEN, U., REFSGAARD, J., ZEUTHEN, E., SOEGAARD, P., HRANAI, M., GASPAR, L., PELLA, D., HATALOVA, K., DROZDAKOVA, E., COMAN, I., DIMULESCU, D., VINEREANU, D., CINTEZA, M., SINESCU, C., ARSENESCU, C., BENEDEK, I., BOBESCU, E., DOBREANU, D., GAITA, D., IANCU, A., ILIESIU, A., LIGHEZAN, D., PETRESCU, L., PIRVU, O., TEODORESCU, I., TESLOIANU, D., VINTILA, M. M., & CHIONCEL, O.
- Affiliations
- Population Health Research Institute (CA)
- Charles University (CZ)
- Thrombosis Research Institute (GB)
- Semmelweis University (HU)
- Associazione Nazionale Medici Cardiologi Ospedalieri (IT)
- University of Würzburg (DE)
- Fu Wai Hospital (CN)
- Ollscoil na Gaillimhe – University of Galway (IE)
- University of Edinburgh (GB)
- Brigham and Women's Hospital (US)
- Bayer (Germany) (DE)
- Monash University (AU)
- KU Leuven (BE)
- Bayer (United States) (US)
- Universidad Autónoma de Madrid (ES)
- Estudios Clínicos Latinoamérica (AR)
- Hamilton General Hospital (CA)
- McMaster University (CA)
- University of Washington (US)
- Université de Versailles Saint-Quentin-en-Yvelines (FR)
- Centre Hospitalier Universitaire de Montpellier (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Paris Cardiovascular Research Center (FR)
- University of Cape Town (ZA)
- Centre Hospitalier Universitaire de Nîmes (FR)
- Centre Hospitalier Universitaire de Clermont-Ferrand (FR)
- Werkgroep Cardiologische centra Nederland (NL)
- University of Debrecen (HU)
- University of Trieste (IT)
- Sahlgrenska University Hospital (SE)
- Karolinska Institutet (SE)
- Hôpital Universitaire Dupuytren (FR)
- Istituto Cardiocentro Ticino (CH)
- Danylo Halytsky Lviv National Medical University (UA)
- Foscal Hospital (CO)
- National Research Center for Preventive Medicine (RU)
- Carol Davila University of Medicine and Pharmacy (RO)
- Institutul de Urgenţă pentru Boli Cardiovasculare "Prof.Dr. C.C. Iliescu" (RO)
- Corresponding author
- Anand, Sonia S
- ORCID
- Anand, Sonia S
- Bosch, Jackie
- Eikelboom, John W
- Connolly, Stuart J
- Kakkar, Ajay K
- Keltai, Katalin
- Maggioni, Aldo P
- Störk, Stefan
- Zhu, Jun
- O'Donnell, Martin
- Fox, Keith A A
- Bhatt, Deepak L
- Misselwitz, Frank
- Vanassche, Thomas
- Leong, Darryl P
- Bangdiwala, Shrikant I
- Hart, Robert G
- Yusuf, Salim
- SCHYGIEL, PABLO OMAR
- COSTABEL, JUAN PABLO
- MACIN, STELLA MARIS
- GRINFELD, DIEGO
- VERHAMME, PETER
- DEBONNAIRE, PHILIPPE
- VRANCKX, PASCAL
- ELEGEERT, IVAN
- HOFFER, ETIENNE
- MANENTI, EULER
- REIS, GILMAR
- HERNANDES, MAURO
- TANAJURA, LUIZ FERNANDO
- TYTUS, RICHARD
- LONN, EVA
- LAMY, ANDRE
- NOISEUX, NICOLAS
- BAINEY, KEVIN
- DAGENAIS, GILLES R
- NGUYEN, MICHEL
- GUZMAN, RANDOLPH
- KHAYKIN, YAARIV
- GOSSELIN, GILBERT
- HUYNH, THAO
- ROY, ANNIE
- JIA, KAIYING
- WU, SHULIN
- ZHANG, JIWEI
- GE, JUNBO
- FU, GUOSHENG
- VESGA, BORIS
- LUBANDA, JEAN-CLAUDE
- MOTOVSKA, ZUZANA
- BRANNY, MARIAN
- HOMZA, MIROSLAV
- BRTKO, MIROSLAV
- DUARTE, YAN CARLOS
- SANCHEZ, MAYRA
- TUOMILEHTO, JAAKKO
- KANTOLA, ILKKA
- LECLERCQ, FLORENCE
- BOCCARA, FRANCK
- MESSAS, EMMANUEL
- SEVESTRE, MARIE ANTOINETTE
- CAYLA, GUILLAUME
- MOTREFF, PASCAL
- STELLBRINK, CHRISTOPH
- OPITZ, CHRISTIAN
- NIKOL, SIGRID
- SCHELLONG, SEBASTIAN
- DAVIERWALA, PIROZE
- VORPAHL, MARC
- KORANYI, LASZLO
- MURPHY, ANDREW
- MAHON, NIALL
- HALABI, MAJDI
- ZELTSER, DAVID
- KATZ, AMOS
- ATAR, SHAUL
- FAGGIANO, POMPILIO
- ROBBA, DEBORA
- MOS, LUCIO
- SINAGRA, GIANFRANCO
- GULIZIA, MICHELE MASSIMO
- GALVANI, MARCELLO
- PERNA, GIAN PIERO
- OZAKI, YUKIO
- HIGASHIUE, SHINICHI
- HOSOKAWA, SHINOBU
- FUJII, KENSHI
- KIMURA, KAZUO
- HIGUCHI, YOSHIHARU
- NODA, TOSHIYUKI
- HIRAYAMA, ATSUSHI
- INOKO, MORIAKI
- MANITA, MAMORU
- AKO, JUNYA
- YOSHIDA, TETSURO
- SHIMOMURA, HIDEKI
- KINOSHITA, NORIYUKI
- TAKAHASHI, AKIHIKO
- YUSOFF, KHALID
- KASIM, SAZZLI
- NAKANO, AKIHIKO
- NAKAMURA, SHIGERU
- SAKAMOTO, TOMOHIRO
- RONNER, EELKO
- BARTELS, GERARD
- ABOLA, MARIA TERESA
- ABAT, MARC EVANS
- JANION, MARIANNA
- GUZIK, TOMASZ
- GAJOS, GRZEGORZ
- RYNKIEWICZ, ANDRZEJ
- BRONCEL, MARLENA
- SZUBA, ANDRZEJ
- CZARNECKA, DANUTA
- SIZOVA, ZHANNA
- VOEVODA, MIKHAIL
- REPIN, ALEXEY
- EFREMUSHKINA, ANNA
- ZATEYSHCHIKOV, DMITRY
- BAE, JANG-HO
- HA, JONG-WON
- MOOE, THOMAS
- DELLBORG, MIKAEL
- ALBERTSSON, PER
- WAHLGREN, CARL-MAGNUS
- MOCCETTI, TIZIANO
- PARKHOMENKO, ALEXANDER
- TSELUYKO, VIRA
- KOVAL, OLENA
- BAZYLEVYCH, ANDRIY
- KARPENKO, OLEKSANDR
- MALYNOVSKY, YAROSLAV
- COTTON, JAMES
- CONNOLLY, DEREK
- DAVEY, PATRICK
- SENIOR, ROXY
- PEACE, AARON
- AUSTIN, DAVID
- SRIVASTAVA, SUNNY
- SHAMMAS, NICOLAS
- GURBEL, PAUL
- BANERJEE, SUBHASH
- MEHTA, RAJENDRA
- GILLESPIE, EVE
- HAMROFF, GLENN
- LADER, ELLIS
- KOSTIS, JOHN B.
- BITTNER, VERA
- CHILTON, ROBERT
- COMEROTA, ANTHONY
- BAKAEEN, FAISAL
- AMERENA, JOHN
- ROYSE, ALISTAIR
- SELVANAYAGAM, JOSEPH
- JANSEN, SHIRLEY
- HAMMETT, CHRISTOPHER
- POULTER, ROHAN
- NARASIMHAN, SESHASAYEE
- GISLASON, GUNNAR
- HOULIND, KIM
- DIXEN, ULRIK
- REFSGAARD, JENS
- PELLA, DANIEL
- SINESCU, CRINA
- BENEDEK, IMRE
- BOBESCU, ELENA
- DOBREANU, DAN
- IANCU, ADRIAN
- LIGHEZAN, DANIEL
- PETRESCU, LUCIAN
- TESLOIANU, DAN
- CHIONCEL, OVIDIU
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 391
- Issue
- 10117
- Pages
- 219-229
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W4229536675
- Semantic Scholar
- af705d340539758c05004e20b5429bd9700e2fc2
- Cited by
- 879
- References
- 30
- Citations by year
- 2026: 52 · 2025: 62 · 2024: 74 · 2023: 99 · 2022: 109 · 2021: 139 · 2020: 152 · 2019: 112 · 2018: 74
- FWCI
- 72.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion)
- HAL (submittedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc-nd)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by-sa)
- Lirias (submittedVersion)
- Scopus (Elsevier) (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by-nc-nd)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- rivaroxaban, aspirin, peripheral arterial disease, carotid artery disease, coronary artery disease, major adverse limb events, major amputation, cardiovascular mortality, myocardial infarction, stroke, antiplatelet therapy, direct oral anticoagulants, ankle-brachial index, intermittent claudication, asymptomatic carotid stenosis
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