Korjian S, et al. - Researchers investigated whether patients with both acute coronary syndromes (ACS) and congestive heart failure (CHF) would especially derive benefit from antithrombotic therapy with rivaroxaban, as these subjects are at an increased risk of recurrent cardiovascular (CV) events attributed in part to both excess thrombin generation and impaired fibrinolysis. They performed a post-hoc subgroup analysis of the ATLAS-ACS-2 TIMI-51 which was a double-blind, multicenter, phase 3 clinical trial that randomized patients within 7 days of an ACS event to standard of care plus either rivaroxaban 2.5 mg BID, 5 mg BID, or placebo (n=15,526). In this subgroup analysis, subjects with a history of CHF at randomization (n=1,694) were assessed. They found that the composite of CV death, MI, or stroke was reduced, without an increase in non-CABG-related major bleeding, when rivaroxaban was used for secondary prevention in ACS patients with a history of CHF.