This new guideline from Nice states that rivaroxaban can now be used after ACS with elevated cardiac enzymes. It should be used either with aspirin, or with aspirin and clopidogrel together.
- It decreases the combined end points of MI, CVA or deaths from cardiovascular events by 20%.
- There is a 3 x increased risk of major bleeding, so bleeding risk must be assessed.
- Use beyond 12m hasn't been studied, so use beyond that point is for clinical judgement.
It is generally started about a week after the event, so it is likely that we will be starting it, though hopefully it will be advised in the discharge summary.