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Confidence through Mortality Benefit after ACS1-3

Secondary Prevention in Acute Coronary Syndrome

Xarelto is indicated for the prevention of atherothrombotic events in adult patients after ACS 2

Achieve comprehensive Protection1,2,4

Combining Xarelto^® 2.5 mg BID with standard antiplatelet therapy* can protect adult patients after ACS with elevated biomarkers^† against further events1,2

Xarelto achieves more comprehensive protection than antiplatelet therapy alone1

Arterial Clots are Formed Through Dual Pathways3

Thrombin is one of the most potent platelet activators2,5,6
Both pathways are addressed with antiplatelets and anticoagulants respectively during the acute phase7

Achieve More Comprehensive Protection with Xarelto 2.5 mg BID in Secondary Prevention1,2

Achieve More Comprehensive Protection with Xarelto in Secondary Prevention after ACS

BID, twice daily. * ASA alone or ASA plus clopidogrel or ticlopidine. ^†Those with elevated troponin-I/T or creatine kinase-muscle and brain isoenzyme (CK-MB) and without prior stroke/ TIA .

Combining Xarelto 2.5 mg BID with standard antiplatelet therapy* can protect selected patients^† against further events1,2

Thrombin Level Remains Elevated Long After the Acute Event8

Xarelto with standard antiplatelet therapya can protect selected patientsb against further events

nM, nanomolar. * Prothrombin fragment 1+2 is a surrogate marker of Factor Xa -mediated prothrombin activation. Error bars show the upper interquartile range.

As the thrombin level remains elevated, secondary prevention after ACS should also target the coagulation cascade with Xarelto 2.5 mg BID8

Reduce mortality and CV events1,4

Significant risk reduction in ACS patients with elevated cardiac biomarkers^† and without prior stroke/ TIA 1

A dual inhibition strategy can have significant CV benefits1

Reduce CV Mortality, MI or Stroke Further with Xarelto 2.5 mg BID1

ACS , acute coronary syndrome; ASA, acetylsalicylic acid; BID, twice daily; CV, cardiovascular; MI , myocardial infarction; RRR , relative risk reduction; TIA , transient ischaemic attack. * In combination with ASA alone or ASA plus clopidogrel or ticlopidine. ^†Troponin-I/T; creatine kinase-muscle and brain isoenzyme (CK-MB).

Significant risk reduction in ACS patients with elevated cardiac biomarkers^† and without prior stroke/ TIA 1

Reduce All-Cause Mortality Further with Xarelto 2.5 mg BID1

ACS , acute coronary syndrome; ASA, acetylsalicyclic acid; BID, twice daily; RRR , relative risk reduction; TIA , transient ischaemic attack. * In combination with ASA alone or ASA clopidogrel or ticlopidine. ^†Troponin-I/T; creatine kinase-muscle and brain isoenzyme (CK-MB).

Significant risk reduction in ACS patients with elevated cardiac biomarkers^† and without prior stroke/ TIA 1

Reduce CV Mortality Further with Xarelto 2.5 mg BID1

Significant risk reduction in ACS patients with elevated cardiac biomarkers and without prior stroke/TIA

ACS , acute coronary syndrome; ASA, acetylsalicyclic acid; BID, twice daily; RRR , relative risk reduction; TIA , transient ischaemic attack. * In combination with ASA alone or ASA clopidogrel or ticlopidine. ^†Troponin-I/T; creatine kinase-muscle and brain isoenzyme (CK-MB).

Significant risk reduction in ACS patients with elevated cardiac biomarkers^† and without prior stroke/ TIA 1

Maximise the benefits of Xarelto® for your patients2

Combined therapy with Xarelto 2.5 mg BID for up to 12 months can protect patients with the right balance of safety and efficacy2

A selective approach is endorsed by the ESC 2017 STEMI guidelines9

Safety Endpoints10

Maximise the Benefits of Xarelto for Your Patients2

ACS , acute coronary syndrome; ASA, acetylsalicylic acid; BID, twice daily; CABG , coronary artery bypass graft; ICH , intracranial haemorrhage; ns, not significant; TIA , transient ischaemic attack; TIMI , thrombolysis in myocardial infarction. * ASA alone or ASA plus clopidogrel or ticlopidine. ^†Troponin-I/T; creatine kinase-muscle and brain isoenzyme (CK-MB).

Fatal bleeding and fatal ICH are comparable to placebo plus standard antiplatelet therapy. As expected, the rate of TIMI major bleeding vs placebo is increased by Xarelto 2.5 mg BID1

Ensure Responsible Use

With increased ischaemic risk2
- Elevated cardiac biomarkers^†

Without increased bleeding risk2
- No prior stroke or TIA
- No current or recent condition at significant risk of major bleeding
- Creatine clearance ≥15 ml/min
- No concomitant anticoagulation
- Other risk factors – refer to full SPC before prescribing

Select the Right Dose for the Right Duration

3 Dose modification should be avoided. Extension of treatment beyond 12 months should be done on an individual patient basis2

ACS; acute coronary syndrome; BID, twice daily; CV, cardiovascular; TIA, transient ischaemic attack.
* ASA alone or ASA plus clopidogrel or ticlopidine.
^†Troponin-I/T; creatine kinase-muscle and brain isoenzyme (CK-MB).

PP-XAR-ALL-1792-1

References

Korjian S et al. Eur Heart J. 2017; 8(2):186-193. Korjian S et al. Eur Heart J. 2017; 8(2):186-193. Return to content
Xarelto^® (rivaroxaban) Summary of Product Characteristics. Xarelto^® (rivaroxaban) Summary of Product Characteristics. Return to content
Cohen M and Iyer D. Cardiovasc Ther. 2014;32:224–232. Cohen M and Iyer D. Cardiovasc Ther. 2014;32:224–232. Return to content
Korjian S, et al. Eur Heart J Acute Cardiovasc Care. 2019:8:186–193. Korjian S, et al. Eur Heart J Acute Cardiovasc Care. 2019:8:186–193. Return to content
Leger AJ, et al. Circulation 2006; 113:1244–1254. Return to content
Smyth SS, et al. Arterioscler Thromb Vasc Biol. 2009;29:449–457. Return to content
Hamm CW, et al. Eur Heart J. 2011;32:2999–3054. Return to content
Ardissino D, et al. Blood. 2003;102:2731–2735. Return to content
Ibanez B, et al. Eur Heart J. 2018;39:119–177. Return to content
Mega JL, et al. Rivaroxaban in patients after an acute coronary syndrome with cardiac biomarker elevation (with or without prior stroke or TIA): insights from the ATLAS ACS 2 TIMI 51 trial. Presented at: European Society of Cardiology (ESC), 30 August–03 September, 2014; Barcelona, Spain. Mega JL, et al. Rivaroxaban in patients after an acute coronary syndrome with cardiac biomarker elevation (with or without prior stroke or TIA): insights from the ATLAS ACS 2 TIMI 51 trial. Presented at: European Society of Cardiology (ESC), 30 August–03 September, 2014; Barcelona, Spain. Return to content

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DOSING GUIDE

PRACTICAL MANAGEMENT

PRESCRIBING INFORMATION

Confidence through Mortality Benefit after ACS1-3

Secondary Prevention in Acute Coronary Syndrome

Achieve comprehensive Protection1,2,4

Arterial Clots are Formed Through Dual Pathways3

Achieve More Comprehensive Protection with Xarelto 2.5 mg BID in Secondary Prevention1,2

Thrombin Level Remains Elevated Long After the Acute Event8

Reduce mortality and CV events1,4

Reduce CV Mortality, MI or Stroke Further with Xarelto 2.5 mg BID1

Reduce All-Cause Mortality Further with Xarelto 2.5 mg BID1

Reduce CV Mortality Further with Xarelto 2.5 mg BID1

Maximise the benefits of Xarelto® for your patients2

Safety Endpoints10

Ensure Responsible Use

Select the Right Dose for the Right Duration

References

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DOSING GUIDE

PRACTICAL MANAGEMENT

PRESCRIBING INFORMATION

Confidence through Mortality Benefit after ACS1-3

Secondary Prevention in Acute Coronary Syndrome

Achieve comprehensive Protection1,2,4

Arterial Clots are Formed Through Dual Pathways3

Achieve More Comprehensive Protection with Xarelto 2.5 mg BID in Secondary Prevention1,2

Thrombin Level Remains Elevated Long After the Acute Event8

Reduce mortality and CV events1,4

Reduce CV Mortality, MI or Stroke Further with Xarelto 2.5 mg BID1

Reduce All-Cause Mortality Further with Xarelto 2.5 mg BID1

Reduce CV Mortality Further with Xarelto 2.5 mg BID1

Maximise the benefits of Xarelto® for your patients2

Safety Endpoints10

Ensure Responsible Use

Select the Right Dose for the Right Duration

References