Trained Immunity by Dual-pathway Inhibition in Coronary Artery Disease

Inclusion Criteria: In order to be eligible to participate in this study, a subject must meet all of the following criteria: * stable CAD * with an indication for single antiplatelet therapy according to international (ESC) guidelines, * high cardiovascular risk based on a SMART risk score \[9\] of at least 20% and/or the judgement of the cardiologist * at least 1 year after myocardial infarction or multivessel CAD * \>16 years old * Written informed consent Exclusion Criteria: A potential subject who meets any of the following criteria will be excluded from participation in this study: * Use of more intensive antithrombotic treatment (dual antiplatelet therapy, DPI, direct oral anticoagulants, vitamin k antagonists) * Use of immunosuppressant and/or anti-inflammatory therapy, including glucocorticoids, cytostatics, antibodies, immunophilins, interferons, Tumor Necrosis Factor (TNF) binding proteins, mycophenolate and interleukin antagonists * Contra-indication to rivaroxaban * Hypersensitivity to rivaroxaban * at significant risk for major bleeding * current gastrointestinal ulceration * presence of malignant neoplasms, with the exception of non-melanoma skin cancer * recent (\<2 months) brain or spinal injury * recent (\<3 months) brain or spinal surgery * recent (\<3 months) intracranial, gastrointestinal or pulmonary hemorrhage * presence of arteriovenous malformations, * major intraspinal or intracerebral vascular abnormalities * congenital or acquired bleeding disorders * uncontrolled severe arterial hypertension (180 mmHg or more systolic, or 110 mmHg or more diastolic) * Severe hepatic disease: Child Pugh B or C \[10\] * Severe kidney failure: estimated glomerular filtration rate\<15 ml/min or requiring dialysis * severe heart failure with known ejection fraction \< 30% or New York Heart Association class III or IV symptoms \[12\] * concomitant treatment with medication with a strong pharmacokinetic interaction with rivaroxaban, leading to contra-indication according to the "regionale\_NOAC\_richtlijn" \[12\] * Pregnant or breastfeeding women * Unable to give informed consent