Post-Operative Biomarker-Guided Precision Medicine For Cardiovascular Risk Reduction

Inclusion Criteria: 1. Adults ≥45 years 2. Underwent major non-cardiac surgery requiring ≥1 overnight inpatient stay in the prior 14 days 3. Myocardial injury after noncardiac surgery, defined as a post-operative troponin ≥ 99th percentile upper reference limit \[URL\], with rise/fall \>20% indicative of acute myocardial injury. 4. Ability to provide informed consent Exclusion Criteria: 1. Expected survival \<6 months 2. Hemorrhagic disorder 3. Surgeon feels it is unsafe to initiate low-dose anticoagulation within 14 days of surgery 4. Indication for oral anticoagulation at discharge 5. Indication for dual antiplatelet therapy at discharge 6. Patient already receiving or planned to receive moderate or high-intensity statin 7. Contraindication to high-intensity statin 8. Contraindication to rivaroxaban 9. End stage kidney disease on hemodialysis 10. Acute liver failure or decompensated cirrhosis 11. Pregnancy