Effects of rivaroxaban combined with clopidogrel on thrombotic risk and myocardial injury indicators in patients with coronary artery ectasia

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.