- Health Conditions
- XARELTO® for Chronic CAD
- About CAD
Coronary artery disease, or CAD, is a progressive heart disease that is the result of plaque buildup in the arteries that supply blood to the heart. It is also common for people with CAD to have peripheral artery disease, or PAD. People who have both have an even higher risk for blood clot–related events like a heart attack or stroke than people with CAD or PAD alone.
CAD and atherosclerosis
CAD is the end result of atherosclerosis, or hardening of the arteries. This is the process by which the arteries become damaged and inflamed as a result of certain health conditions or risk factors, including:
High blood pressure
Then, like sludge on the inside of pipes, cholesterol, white blood cells, and other substances build up inside the damaged walls, forming plaques. Plaques can start forming as early as childhood and build up slowly, over many years.
As the plaques grow larger, less blood can get through the artery to supply your heart with the oxygen it needs to function. This reduced blood flow may cause symptoms such as:
- Chest pain, or angina
- Shortness of breath
The risk with CAD is that some plaques can rupture. This triggers your body’s blood clotting response. A clot forms around the ruptured plaque, creating a blockage and cutting off blood flow to your heart and causing a heart attack. If that clot breaks off and travels to your brain, it can cause a stroke. Both of these events can be life threatening.
CAD treatment options
Surgical and nonsurgical procedures may be performed to restore blood flow in a blocked artery. Examples include:
- Angioplasty opens a blocked artery by inflating a tiny balloon inside the blockage
- Stent implantation permanently props open a blocked artery with a tiny wire mesh tube that is placed during an angioplasty
- Coronary artery bypass graft surgery (CABG) reroutes blood around a completely blocked artery using a blood vessel from another part of your body
While the above procedures may be life-saving, they do not fix you for good.
Prescription and nonprescription antiplatelet blood thinners may be prescribed immediately following diagnosis or an event to help prevent blood clots. Antiplatelets are one type of blood thinner that work by helping to keep platelets (which are pieces of blood cells) from sticking together. Examples include:
- Dual antiplatelet therapy (DAPT): aspirin plus one other antiplatelet medicine, such as clopidogrel, prasugrel, or ticagrelor, are typically prescribed temporarily to help prevent blood clots after stent implantation, coronary artery bypass graft surgery, or after a heart attack
- Clopidogrel (Plavix®)
- Prasugrel (Effient®)
- Ticagrelor (Brilinta®)
XARELTO® plus low-dose aspirin for chronic CAD
The medicines just discussed, including aspirin, have been recommended to reduce the risk of blood clots in people with chronic CAD. Now, a new medication is available for healthcare professionals to prescribe for people with chronic CAD. XARELTO® is an FDA-approved treatment that can be added to low-dose aspirin to help further reduce the risk of blood clots that may cause a serious cardiovascular event like a heart attack, stroke, or cardiovascular death.
Aspirin alone may not be enough
Even when you’re following your healthcare professional’s instructions to take aspirin every day and to eat right and stay active, you may still have an underlying risk for blood clots that may cause another unexpected cardiovascular event like a heart attack or stroke.
While aspirin alone can help reduce your risk for these events, a large study of almost 40,000 people, including those with CAD or PAD, showed that even though more than half were taking aspirin, the number of heart attacks, strokes, and cardiovascular deaths more than doubled over a two-year period.
Adding XARELTO® to your low-dose aspirin
XARELTO® 2.5 mg twice daily in combination with low-dose aspirin (75 mg–100 mg) once daily is proven to help further reduce the risk of heart attack, stroke, and cardiovascular death in people with chronic CAD versus aspirin alone.
In fact, in a clinical trial, almost 96% of people with chronic CAD or PAD taking XARELTO® 2.5 mg twice daily in combination with low-dose aspirin once daily did not have a heart attack, stroke, or die from a cardiovascular event.*
*Patients were followed for an average length of treatment of 23 months.
How XARELTO® works with aspirin
XARELTO® works together with aspirin to help protect you from blood clots that may cause a heart attack, a stroke, or cardiovascular death. Think of XARELTO® and aspirin like two members of the same team whose job it is to prevent serious blood clots from forming and growing. But they each play different positions—aspirin, an antiplatelet blood thinner, helps keep platelets (which are pieces of blood cells) from sticking together, and XARELTO®, an anticoagulant blood thinner, helps slow down the blood's clotting process.
Until recently, aspirin had to play defense on its own, but a study showed that adding XARELTO® to the team helps further reduce the risk of a heart attack, stroke, and cardiovascular death than aspirin alone.
Bleeding risk with XARELTO® plus low-dose aspirin
While all blood thinners come with a risk of bleeding, just under 3% of people taking XARELTO® 2.5 mg with their low-dose aspirin experienced a major bleed, such as bleeding into the brain. That represents an almost 1% increase in bleeding versus people taking only low-dose aspirin.
But remember, if you and your doctor chose to add XARELTO® to your low-dose aspirin, it’s likely because your doctor believes the benefit of helping to protect you from life-threatening blood clots outweighs your risk of bleeding.
Managing your overall health
It’s important to quit smoking, keep trying to eat right and stay active, and take any other medicines your doctor has prescribed, like medicines for high blood pressure or high cholesterol. Because while no drug or procedure can completely rid your arteries of plaques, managing your overall health can help slow the progression of your CAD.
Start the Conversation
If you have CAD and are taking aspirin, talk to your healthcare professional about your risk for blood clots that may cause a heart-related event such as a heart attack or a stroke and whether adding XARELTO® to your care plan may be right for you.