Rivaroxaban with or without aspirin for prevention of cardiovascular disease.

Cardiovascular (CV) disease affects more than 300 million individuals worldwide and is a growing problem because of the aging of the world population [1,2]. Thrombosis is the most common mechanism leading to the development of acute myocardial infarction (MI) and stroke [3]. Aspirin is effective for prevention of thromboembolic complications in patients with CV disease, but produces only a 19% relative risk (RR) reduction during long-term treatment [Rate ratio: 0.81; 95% confidence interval (CI): 0.75–0.87; P< 0.00001], including a 20% reduction in major coronary events, 19% reduction in stroke, and 9% reduction in vascular mortality [4]. Evidence of persistent coagulation and platelet activation despite the use of aspirin [5] raises the possibility that more intensive antithrombotic therapies could provide additional benefit.

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