Differential EFfects of Dual antIplatelet and Dual aNtithrombotic thErapy on Hemostasis in Chronic Coronary Syndrome Patients

Participation Requirements

• Sex:

  ALL

• Eligible Ages:

  55 and up

Participation Criteria

Inclusion Criteria:

* Patients with chronic coronary syndrome (at least 1 year after having a myocardial infarction) on aspirin monotherapy will be eligible for this study. They have to have at least one of these additional risk factors:

1. Diffuse coronary artery disease.
2. Peripheral vascular disease
3. Diabetes
4. Chronic kidney disease (eGFR\<60 ml/unit/1.73 m2)

Exclusion Criteria:

* Allergy to either rivaroxaban or ticagrelor
* Requirement for anticoagulation or P2Y12 inhibitor therapy
* Anemia (hemoglobin \< 10 g/dL)
* Severe renal impairment (eGFR \< 30 ml/unit/1.73 m2)
* Bleeding disorders
* Significant liver impairment resulting in deranged clotting parameters
* Any history of intracranial hemorrhage
* Stroke within 6 months
* History of gastrointestinal bleed within 6 months
* Major surgery within 1 month
* Patients with inflammatory conditions
* Concomitant treatment with immunosuppressive therapy, inhibitors or inducers of P glycoprotein or CYP3A4 enzymes (eg. azole antifungals, ritonavir, erythromycin, clarithromycin, rifampicin)
* Concomitant treatment with antidepressants (selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors)
* Pregnancy
* Inability to give written consent