Objective:

To evaluate the efficacy and safety of low-dose rivaroxaban combined with single antiplatelet therapy in patients with coronary artery ectasia (CAE).

Approach:

• Study Design: Single-center retrospective cohort study involving 312 patients with CAE followed for 36 months.
• Intervention: Patients received either single antiplatelet therapy alone or in combination with low-dose rivaroxaban.
• Analysis Methods: Propensity score matching, Cox proportional hazards models, inverse probability weighting, competing risk models, and sensitivity analyses.

Key Findings:

• Combination therapy was associated with a significantly lower risk of 36-month major adverse cardiovascular events (MACE) compared to antiplatelet therapy alone (8.1% vs. 21.8%; HR = 0.34, 95% CI: 0.19–0.62; P < 0.001).
• Absolute risk reduction was 13.7% with a number needed to treat of 7.3.
• Benefits were more pronounced in patients with diffuse ectasia and elevated baseline D-dimer (≥0.8 mg/L: HR = 0.18, 95% CI: 0.08–0.41; interaction P = 0.01).
• Improvements in D-dimer, inflammatory markers, and myocardial injury biomarkers were greater in the combination group.
• Total bleeding rates were not significantly different between groups, with no fatal bleeding reported.

Interpretation:

Low-dose rivaroxaban combined with single antiplatelet therapy is associated with lower long-term MACE risk in CAE patients without a significant increase in major bleeding.

Limitations:

• The study is retrospective and conducted at a single center.
• The predictive model developed requires external validation.

Conclusion:

The combination of low-dose rivaroxaban and antiplatelet therapy was associated with lower long-term MACE risk in CAE patients, particularly those with diffuse ectasia and higher thrombotic burden.