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