Effects of rivaroxaban combined with clopidogrel on thrombotic risk and myocardial injury indicators in patients with coronary artery ectasia
- 1Department of Cardiology, Cangzhou Central Hospital of Hebei Medical University , , ,
- 2Department of Cardiology, The Second Hospital of Tianjin Medical University , ,
Abstract
Objective: To investigate the association between rivaroxaban combined with clopidogrel therapy and thrombotic risk, platelet activation, myocardial injury biomarkers, and clinical outcomes in patients with coronary artery ectasia (CAE).
Methods: This single-center retrospective cohort study included 158 consecutive patients with CAE diagnosed by coronary angiography between June 2023 and June 2025. Patients receiving clopidogrel alone or rivaroxaban plus clopidogrel were compared. A 1:1 nearest-neighbor propensity score matching method was applied, generating 70 matched pairs. Thrombotic risk markers, including D-dimer (D-D), thrombin-antithrombin complex (TAT), and von Willebrand factor (vWF), platelet activation parameters [ADP-induced platelet aggregation rate (ADP-PAg) and CD62P], thromboelastography parameters [maximum amplitude (MA) and reaction time (R)], and myocardial injury-related biomarkers [high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase-MB (CK-MB), heart-type fatty acid-binding protein (H-FABP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP)] were evaluated at baseline and 6 months. Clinical outcomes, including thrombotic-related adverse cardiovascular events and bleeding events, were recorded during 12 months of follow-up.
Results: After propensity score matching, baseline characteristics were well balanced between groups. At 6 months, patients receiving rivaroxaban plus clopidogrel showed lower levels of D-D, TAT, vWF, ADP-PAg, CD62P, MA, hs-cTnT, CK-MB, H-FABP, and NT-proBNP, as well as prolonged R values, compared with those receiving clopidogrel alone (all P < 0.05). During follow-up, thrombotic-related adverse cardiovascular events occurred less frequently in the combination therapy group than in the clopidogrel group (7.14% vs. 20.00%, P = 0.027). Minor bleeding events were numerically higher in the combination therapy group (17.14% vs. 10.00%, P = 0.218), while no intracranial or fatal bleeding events occurred.
Conclusion: Among patients with CAE, rivaroxaban combined with clopidogrel was associated with more favorable changes in coagulation activation, platelet activity, myocardial injury biomarkers, and thrombotic-related clinical outcomes compared with clopidogrel alone. These findings suggest that combined anticoagulant and antiplatelet therapy may represent a potential strategy for selected high-risk patients with CAE. Further multicenter prospective studies are required to confirm these observations.
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BibTeX
@article{geng2026effects,
title = {{Effects of rivaroxaban combined with clopidogrel on thrombotic risk and myocardial injury indicators in patients with coronary artery ectasia}},
author = {Tao Geng and Mengwei Feng and Yunjie Wu and Zhaoqing Xie and Jingxian Xing and Deguang Wang and Xue Liang and Juan Liu and Hui Gao},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1912975},
url = {https://europepmc.org/article/PMC/PMC13690761},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effects of rivaroxaban combined with clopidogrel on thrombotic risk and myocardial injury indicators in patients with coronary artery ectasia
AU - Tao Geng
AU - Mengwei Feng
AU - Yunjie Wu
AU - Zhaoqing Xie
AU - Jingxian Xing
AU - Deguang Wang
AU - Xue Liang
AU - Juan Liu
AU - Hui Gao
PY - 2026
DA - 2026/10/09
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1912975
UR - https://europepmc.org/article/PMC/PMC13690761
AB - Objective: To investigate the association between rivaroxaban combined with clopidogrel therapy and thrombotic risk, platelet activation, myocardial injury biomarkers, and clinical outcomes in patients with coronary artery ectasia (CAE). Methods: This single-center retrospective cohort study included 158 consecutive patients with CAE diagnosed by coronary angiography between June 2023 and June 2025. Patients receiving clopidogrel alone or rivaroxaban plus clopidogrel were compared. A 1:1 nearest-neighbor propensity score matching method was applied, generating 70 matched pairs. Thrombotic risk markers, including D-dimer (D-D), thrombin-antithrombin complex (TAT), and von Willebrand factor (vWF), platelet activation parameters [ADP-induced platelet aggregation rate (ADP-PAg) and CD62P], thromboelastography parameters [maximum amplitude (MA) and reaction time (R)], and myocardial injury-related biomarkers [high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase-MB (CK-MB), heart-type fatty acid-binding protein (H-FABP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP)] were evaluated at baseline and 6 months. Clinical outcomes, including thrombotic-related adverse cardiovascular events and bleeding events, were recorded during 12 months of follow-up. Results: After propensity score matching, baseline characteristics were well balanced between groups. At 6 months, patients receiving rivaroxaban plus clopidogrel showed lower levels of D-D, TAT, vWF, ADP-PAg, CD62P, MA, hs-cTnT, CK-MB, H-FABP, and NT-proBNP, as well as prolonged R values, compared with those receiving clopidogrel alone (all P < 0.05). During follow-up, thrombotic-related adverse cardiovascular events occurred less frequently in the combination therapy group than in the clopidogrel group (7.14% vs. 20.00%, P = 0.027). Minor bleeding events were numerically higher in the combination therapy group (17.14% vs. 10.00%, P = 0.218), while no intracranial or fatal bleeding events occurred. Conclusion: Among patients with CAE, rivaroxaban combined with clopidogrel was associated with more favorable changes in coagulation activation, platelet activity, myocardial injury biomarkers, and thrombotic-related clinical outcomes compared with clopidogrel alone. These findings suggest that combined anticoagulant and antiplatelet therapy may represent a potential strategy for selected high-risk patients with CAE. Further multicenter prospective studies are required to confirm these observations.
SN - 2297-055X
ER -