Physicians' Academy for Cardiovascular Education

Safety of NOAC instead of aspirin in ACS patients

Clinically significant bleeding with low-dose rivaroxaban versus aspirin, in addition to P2Y12 inhibition, in acute coronary syndromes (GEMINI-ACS-1): a double-blind, multicentre, randomised trial

Presented at ACC.17 by Magnus E Ohman

News - Mar. 18, 2017


Dual antiplatelet therapy (DAPT) has been the cornerstone of the treatment of ACS and is recommended by guidelines for the post-ACS therapy. However, despite optimal DAPT, approximately 10% of ACS patients present with recurrent ischaemic events. The addition of certain anticoagulants to DAPT led to further reduction of ischaemic events in this setting, with a 3- to 4-fold increase in major bleedings. Studies including patients with an indication for full-dose oral anticoagulation undergoing PCI, suggested, however, that withholding aspirin was not associated with an increase in ischaemic events but with a lower risk of major bleedings.

In this study, the safety of a low dose of the oral anticoagulant rivaroxaban, a direct factor Xa inhibitor, was compared with aspirin, on top of a P2Y12 inhibitor, in 3037 post-ACS patients.

Main results


A safety study of rivaroxaban versus aspirin, on top of P2Y12 therapy in ACS patients, showed that this dual antithrombotic regimen had a similar risk of clinically significant bleeding. These findings suggest that substituting aspirin with low-dose rivaroxaban is a safe therapeutic option in this setting.


Our coverage of ACC.17 is based on the information provided during the congress.

The accompanying article was published today in The Lancet

Share this page with your colleagues and friends: