Oral
anticoagulants (OACs) are widely used for prevention of systemic
thromboembolism, including the reduction of the risk of
stroke in patients with
atrial fibrillation (AF) and prosthetic heart valves. There is also an increasing population of patients who require not only OACs, but also double antiplatelet
therapy (
DAPT). A typical example is a patient with AF and stable
coronary artery disease or
acute coronary syndrome (ACS), treated by
percutaneous coronary intervention. In recent years, with the introduction of NOACs, triple or dual
therapy has become safer. Regardless of these indications for the use of NOACs,
rivaroxaban at a reduced dose has proved to efficiently reduce the risk of further thrombotic events when added to
DAPT in patients who have suffered an ACS. However, such
therapy increases the incidence of
bleeding complications. Interesting was also the potential impact of the pleiotropic mechanism of action of non-
vitamin K antagonist oral
anticoagulants (NOACs) through protease‑activated receptors 1 and 2, present on the platelets and many other cells, and changing the course of arterial
atherosclerosis. The COMPASS trial has shown that in the group treated with
rivaroxaban combined with
aspirin, the primary outcome (cardiovascular death,
stroke, and
myocardial infarction) occurred significantly less frequently than in the group treated only with
aspirin. However, a significantly higher number of bleedings was observed. In the subgroup of patients with
peripheral artery disease, a significant reduction of the incidence of
amputations was shown. The outcomes of the COMPASS trial might be a breakthrough in the treatment of coronary and peripheral
atherosclerosis.