The COMMANDER HF trial, presented at the 2018 ESC Congress, was designed to test the hypothesis that rivaroxaban would be beneficial in patients with heart failure (HF) and coronary artery disease, but without atrial fibrillation, on the basis that thrombin-related pathways are activated in these individuals and predict a poor prognosis. A total of 5,022 patients were randomly assigned to low-dose rivaroxaban (2.5 mg) twice daily or placebo in addition to standard care after treatment for an episode of worsening HF. During follow-up (median 21.1 months), the rate of the primary efficacy end point (a composite of all-cause death, myocardial infarction, or stroke) was not significantly different between rivaroxaban and placebo (25.0% versus 26.2%; HR 0.94, 95% CI 0.84–1.05). Similarly, no significant difference was observed in the rate of the principal safety outcome (21.8% versus 22.1%; HR 0.80, 95% CI 0.43–1.49).