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 ACS1

Achieve Comprehensive Protection1,2,3

Combining Xarelto 2.5 mg BID with standard antiplatelet therapya can protect adult patients after ACS ACS
Acute coronary syndrome (= ACS). An umbrella term used to cover any group of clinical symptoms compatible with an acute heart attack. The subtypes of ACS include unstable angina (in which the heart muscle is not damaged), and two forms of heart attack in which the heart muscle is damaged. These latter types are named according to the appearance of the electrocardiogram as non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI).
with elevated biomarkersb against further events1,2

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Xarelto achieves more comprehensive protection than antiplatelet therapy alone1

 

Arterial Clots are Formed Through Dual Pathways3
Arterial Clots are Formed Through Dual Pathways
  • Thrombin Thrombin
    Enzyme in the blood clotting cascade that promotes the formation of blood clots.
    is one of the most potent platelet activators2,5,6
  • Both pathways are addressed with antiplatelets and anticoagulants respectively during the acute phase4
 
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. aASA alone or ASA plus clopidogrel or ticlopidine. bThose with elevated troponin-I/T or creatine kinase-muscle and brain isoenzyme (CK-MB) and without prior stroke/TIA TIA
Transient ischaemic attack (= TIA). Also known as a ‘mini stroke’. This is caused by a temporary disruption in the blood supply to part of the brain.
.

  • Combining Xarelto 2.5 mg BID with standard antiplatelet therapya can protect selected patientsb against further events1,2
 
Thrombin Level Remains Elevated Long After the Acute Event5
Xarelto with standard antiplatelet therapya can protect selected patientsb against further events

nM, nanomolar. aProthrombin Prothrombin
Inactive version of thrombin, the enzyme in the coagulation cascade that promotes the formation of blood clots. Factor Xa stimulates the conversion of prothrombin to thrombin.
fragment 1+2 is a surrogate marker of Factor Xa Factor Xa
Pivotal component of blood clotting cascade. Stimulates the production of thrombin, the enzyme in the coagulation cascade that promotes the formation of blood clots.
-mediated prothrombin prothrombin
Inactive version of thrombin, the enzyme in the coagulation cascade that promotes the formation of blood clots. Factor Xa stimulates the conversion of prothrombin to thrombin.
activation. Error bars show the upper interquartile range.

  • As the thrombin thrombin
    Enzyme in the blood clotting cascade that promotes the formation of blood clots.
    level remains elevated, secondary prevention after ACS ACS
    Acute coronary syndrome (= ACS). An umbrella term used to cover any group of clinical symptoms compatible with an acute heart attack. The subtypes of ACS include unstable angina (in which the heart muscle is not damaged), and two forms of heart attack in which the heart muscle is damaged. These latter types are named according to the appearance of the electrocardiogram as non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI).
    should also target the coagulation cascade coagulation cascade
    A chain of biochemical reactions that result in clot formation. Anticoagulants work by blocking or regulating a stage, or stages, of the coagulation cascade.
    with Xarelto 2.5 mg BID5

Reduce Mortality and CV Events1,4

Significant risk reduction in ACS ACS
Acute coronary syndrome (= ACS). An umbrella term used to cover any group of clinical symptoms compatible with an acute heart attack. The subtypes of ACS include unstable angina (in which the heart muscle is not damaged), and two forms of heart attack in which the heart muscle is damaged. These latter types are named according to the appearance of the electrocardiogram as non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI).
patients with elevated cardiac biomarkersb and without prior stroke/TIA TIA
Transient ischaemic attack (= TIA). Also known as a ‘mini stroke’. This is caused by a temporary disruption in the blood supply to part of the brain.
1

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A dual inhibition strategy can have significant CV benefits1

 

Reduce CV Mortality, MI MI
Myocardial infarction (= MI). This is commonly known as a heart attack. This is usually caused by a blood clot that stops the blood flowing to part of the heart muscle. As a result, the heart muscle becomes damaged.
or Stroke Further with Xarelto 2.5 mg BID1
Reduce CV Mortality, MI or Stroke Further with Xarelto

CV, cardiovascular; MI, myocardial infarction; BID, twice daily; ASA, acetylsalicylic acid; RRR RRR
Relative risk reduction (= RRR). Proportion of the control group experiencing a given outcome minus the proportion of the treatment group experiencing the outcome, divided by the proportion of the control group experiencing the outcome.
, relative risk reduction; ACS ACS
Acute coronary syndrome (= ACS). An umbrella term used to cover any group of clinical symptoms compatible with an acute heart attack. The subtypes of ACS include unstable angina (in which the heart muscle is not damaged), and two forms of heart attack in which the heart muscle is damaged. These latter types are named according to the appearance of the electrocardiogram as non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI).
, acute coronary syndrome; TIA TIA
Transient ischaemic attack (= TIA). Also known as a ‘mini stroke’. This is caused by a temporary disruption in the blood supply to part of the brain.
, transient ischaemic attack. aIn combination with ASA alone or ASA plus clopidogrel or ticlopidine. bTroponin-I/T; creatine kinase-muscle and brain isoenzyme (CK-MB).

  • Significant risk reduction in ACS patients with elevated cardiac biomarkersb and without prior stroke/TIA1
 
Reduce All-Cause Mortality Further with Xarelto 2.5 mg BID1
Reduce All-Cause Mortality Further with Xarelto

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

  • Significant risk reduction in ACS patients with elevated cardiac biomarkersb and without prior stroke/TIA1
 
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

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

  • Significant risk reduction in ACS patients with elevated cardiac biomarkersb and without prior stroke/TIA1

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

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A selective approach is endorsed by the ESC 2017 STEMI guidelines6

 

Safety Endpoints7
Combined therapy with Xarelto for up to 12 months can protect patients with the right balance of safety and efficacy

BID, twice daily; CABG CABG
Coronary artery bypass graft (= CABG). A procedure used to treat coronary heart disease. This surgery diverts blood around narrowed or clogged parts of the major arteries to improve blood flow and oxygen supply to the heart.
, coronary artery bypass graft; TIMI TIMI
Thrombolysis in Myocardial Infarction (= TIMI) bleeding criteria. This is a score used to determine the likelihood of ischaemic events or mortality in patients with unstable angina or non-ST segment elevation myocardial infarction (NSTEMI). There is also a separate TIMI risk score for patients with ST segment elevation myocardial infarction (STEMI).
, thrombolysis in myocardial infarction; ICH ICH
Intracranial haemorrhage (= ICH). This is bleeding within the skull.
, intracranial haemorrhage; ns, not significant; ACS ACS
Acute coronary syndrome (= ACS). An umbrella term used to cover any group of clinical symptoms compatible with an acute heart attack. The subtypes of ACS include unstable angina (in which the heart muscle is not damaged), and two forms of heart attack in which the heart muscle is damaged. These latter types are named according to the appearance of the electrocardiogram as non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI).
, acute coronary syndrome; TIA TIA
Transient ischaemic attack (= TIA). Also known as a ‘mini stroke’. This is caused by a temporary disruption in the blood supply to part of the brain.
, transient ischaemic attack; ASA, acetylsalicylic acid. aASA alone or ASA plus clopidogrel or ticlopidine. bTroponin-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 biomarkersb

 

  • 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
Responsible Use Right Dose for the Right Duration Xarelto and Standard Antiplatelet Therapy
  • 3 Dose modification should be avoided. Extension of treatment beyond 12 months should be done on an individual patient basis2

ACS ACS
Acute coronary syndrome (= ACS). An umbrella term used to cover any group of clinical symptoms compatible with an acute heart attack. The subtypes of ACS include unstable angina (in which the heart muscle is not damaged), and two forms of heart attack in which the heart muscle is damaged. These latter types are named according to the appearance of the electrocardiogram as non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI).
; acute coronary syndrome; BID, twice daily; CV, cardiovascular; TIA TIA
Transient ischaemic attack (= TIA). Also known as a ‘mini stroke’. This is caused by a temporary disruption in the blood supply to part of the brain.
, transient ischaemic attack.
aASA alone or ASA plus clopidogrel or ticlopidine.
bTroponin-I/T; creatine kinase-muscle and brain isoenzyme (CK-MB).