The review is devoted to the analysis of the methods of hemostasis treatment in order to improve the prognosis of patients with chronic ischemic heart disease (IHD). The results of the most significant randomized clinical studies, which evaluated the effectiveness and safety of double antiplatelet therapy in the treatment of patients with chronic IHD, were discussed. The use of rivaroxa-ban in addition to ASA was justified in order to reduce the risk of cardiovascular events in patients with chronic IHD. The results of the COMPASS study, which confirmed the positive effect on the prognosis of patients with chronic IHD or peripheral artery disease of low-dose rivaroxaban and ASA combination therapy, were reviewed in detail. Safety aspects of this therapy were dis-cussed. The results of double antiplatelet therapy and the combination of rivaroxaban and ASA in patients who had previously undergone myocardial infarction are compared. The position of rivaroxaban in the treatment of patients with chronic IHD and sinus rhythm was determined in accordance with the recommendations of the European Society of Cardiologists for the diagnosis and treatment of chronic IHD in 2019. The criteria of high ischemic and high hemorrhagic risks, which should be taken into account when deciding to add rivaroxaban to the ASA therapy, were presented. The expediency of wide application of the combination of rivaroxaban and ASA as a part of complex pharmacotherapy of patients with chronic IHD with high ischemic risk for prevention of cardiovascular complications and reduction of mortality is justified.