Monotherapy may be just as effective as combination therapy for heart failure patients

Written by Ilana Landau, Editor

New data demonstrate that, in patients with co-incident atrial fibrillation and stable coronary artery disease, rivaroxaban monotherapy may be as effective a treatment regime as combination rivaroxaban–antiplatelet therapy for disease management.

Up to 30% of all atrial fibrillation patients have co-incident stable coronary artery disease. Currently, the European Society of Cardiology (ESC; Biot, France) recommends prescription of rivaroxaban monotherapy for these patients who do not require surgical intervention or who have had revascularization therapy more than 1 year prior to receiving rivaroxaban.

In a new study, termed Atrial Fibrillation and Ischemic Events with Rivaroxaban (AFIRE), researchers from the Japan Cardiovascular Research Foundation (Osaka, Japan) investigated the effectiveness of rivaroxaban monotherapy, compared with combination rivaroxaban and antiplatelet therapy, in these patient cohorts.

A total of 2236 patients, across 294 Japanese medical centers, were included in the study.

Frequently asked questions:

Participants were randomly assigned to receive either rivaroxaban monotherapy or rivaroxaban–antiplatelet combination therapy. The primary efficacy study endpoint was incidence of stroke or another major adverse cardiovascular event, such as heart attack.

Amongst patients prescribed rivaroxaban monotherapy, incidence of all-cause mortality was significantly lower compared with patients in receipt of rivaroxaban—antiplatelet therapy, as evidenced by a hazard ratio of 0.55.

Furthermore, compared with patients administered combination therapy, patients who took rivaroxaban only had reduced primary efficacy endpoint incidence.

Satoshi Yasuda, principal study investigator from the National Cerebral and Cardiovascular Centre (Suita, Japan), commented: “The results show that oral anticoagulant monotherapy, avoiding antiplatelet therapy, is a better approach for patients with atrial fibrillation and stable coronary artery disease. Monotherapy was superior to combination therapy for both safety and efficacy, including a mortality benefit.”

Yasuda concluded: “The data support the guideline recommendation of oral anticoagulant monotherapy.”


Yasuda S, Kaikita K, Akao M et al. Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary DiseaseN Engl J Med. doi: 10.1056/NEJMoa1904143. (Epub ahead of print) (2019);

How does rivaroxaban work?

Rivaroxaban is a non-vitamin K antagonist, oral anticoagulant. Rivaroxaban works by inhibiting Factor Xa in the clotting cascade.

What is rivaroxaban used for?

Rivaroxaban is an anticoagulant treatment for the prevention of blood clot formation and blood vessel blockade. Rivaroxaban is used in the management of cardiovascular conditions including atrial fibrillation.

Can atrial fibrillation cause stroke?

Atrial fibrillation can put patients at an increased risk of suffering a stroke event as the inefficient pumping of the heart may result in blood pooling and clotting — the most common cause of stroke.