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The efficacy and safety of rivaroxaban in coronary artery disease patients with heart failure and sinus rhythm: a systematic review and meta-analysis

  • Pharmacodynamics
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To explore the efficacy and safety of rivaroxaban in patients with coronary artery disease (CAD), heart failure (HF) and sinus rhythm (SR).

Methods

Comprehensive literature searches were conducted using the PubMed, Cochrane Library, Embase, CNKI and Wanfang databases from inception to February 2021. Randomized controlled trials (RCTs) focusing on the efficacy and safety of new oral anticoagulant (NOAC) therapy in CAD and HF patients in SR were eligible. Statistical analyses were performed using R Programming Language.

Results

Three RCTs included 10,658 adult patients treated with antiplatelet drugs with or without rivaroxaban were ultimately analysed. The average follow-up period was 20.4–24 months. Rivaroxaban had a favourable point estimate in myocardial infarction (MI) and stroke (MI rivaroxaban group (3.83%, 203/5306) vs. APT group (4.52%, 214/4731), RR = 0.78, 95% CI 0.65–0.94, P < 0.01, I2 = 0%), (stroke: rivaroxaban group (1.60%, 85/5306) vs. APT group (2.52%, 119/4731), RR = 0.64, 95% CI 0.49–0.85, P < 0.01, I2 = 12%) compared with the placebo. Rivaroxaban was comparable to the placebo for all-cause death and major bleeding (all-cause death: rivaroxaban group (12.27%, 688/5606) vs. APT group (14.59%, 737/5052), RR = 0.73, 95% CI 0.49–1.06, P > 0.05, I2 = 87%), (major bleeding: rivaroxaban group (1.52%, 85/5586) vs. APT group (1.37%, 69/5043), RR = 1.18, 95% CI 0.86–1.62, P > 0.05, I2 = 0%).

Conclusions

In SR patients with CAD and HF, the rates of MI and stroke associated with rivaroxaban combined with APT were lower than those associated with APT alone, and the two treatments had similar rates of all-cause death and major bleeding.

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Availability of data and material

All data generated or analysed during this study are included in this published article.

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Funding

This project was supported by funding from the National Natural Science Foundation of China (grant. nos. 82000062 and 81960015), the Young Talents Project Foundation from the Science and Technology Department of Jiangxi Province (grant no. 20204BCJ23020) and the Key Research and Development Program Foundation from the Science and Technology Department of Jiangxi Province (grant no. 20203BBG73052).

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Author notes

  1. Shanshan Xie and Jingjing Chen contributed equally to this study.

Authors and Affiliations

  1. Department of Pharmacy, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China

    Shanshan Xie, Juan Li, Jinjin Wan, Ye Liu, Ruilai Xu & Weifang Zhang

  2. Department of Pharmacy, Guangqian Hospital of Quanzhou, Quanzhou, 362321, China

    Jingjing Chen

  3. Department of Information, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China

    Gang Xiong

  4. Department of Pharmacology, School of Pharmaceutical Science, Nanchang University, Nanchang, 330006, Jiangxi, China

    Juan Li & Weifang Zhang

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  1. Shanshan Xie
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Contributions

ZWF, XRL, XSS and CJJ conceptualized and designed the study, selected the studies and planned the analysis. XSS, GX and CJJ contributed to the development of the selection criteria, the assessment strategy for the risk of bias and the data extraction criteria; LJ provided statistical expertise. ZWF, XRL, XSS and CJJ drafted the manuscript, and WJJ and LY participated in its improvement. All authors read, provided feedback and approved the final manuscript as submitted.

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Correspondence to Ruilai Xu or Weifang Zhang.

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Xie, S., Chen, J., Xiong, G. et al. The efficacy and safety of rivaroxaban in coronary artery disease patients with heart failure and sinus rhythm: a systematic review and meta-analysis. Eur J Clin Pharmacol 77, 1485–1494 (2021). https://doi.org/10.1007/s00228-021-03195-w

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