The Impact of Factor Xa Inhibition on Thrombosis, Platelet Activation, and Endothelial Function in Peripheral Artery Disease

Inclusion criteria: History of peripheral artery disease (PAD) defined as: * Previous aorto-femoral bypass surgery, limb bypass surgery, or percutaneous transluminal angioplasty revascularization of the iliac or infra-inguinal arteries, or * Previous limb or foot amputation for arterial vascular disease, or * An ankle/arm blood pressure (BP) ratio less than 0.90, or * Significant peripheral artery stenosis (≥50%) documented by angiography, or by duplex ultrasound, or * An ankle-brachial index (ABI) greater than 1.4 with a toe-brachial index (TBI) less than 0.7 AND * Willing and able to provide written informed consent * Receiving aspirin therapy prior to enrollment Exclusion Criteria: * High risk of bleeding * Stroke within 1 month of any history of hemorrhagic or lacunar stroke * Severe heart failure with known ejection fraction less than 30% or New York Heart Association (NYHA) class III or IV symptoms * Estimated glomerular filtration rate less than 15 mL/min/1.73m2 * Need for dual-antiplatelet therapy, other non-aspirin antiplatelet therapy, or oral anticoagulant therapy * Known non-cardiovascular disease that is associated with poor prognosis (e.g. metastatic cancer) or that increases the risk of an adverse reaction to study interventions * History of hypersensitivity or known contraindication to rivaroxaban or aspirin * Systemic treatment with strong inhibitors of both CYP 3A4 and p-glycoprotein (e.g. systemic azole antimycotics, such as ketoconazole, and human immu…