[Anti-Thrombotic Treatment of Patients with Peripheral Artery Disease (PAD)]
1Universitätsmedizin der Johannes-Gutenberg-Universität Mainz.
Insights
For peripheral artery disease patients, combining low-dose rivaroxaban with aspirin after revascularization may reduce major adverse events, but increases bleeding risk. This approach is being evaluated in the VOYAGER PAD study.
Area of Science:
- Vascular Medicine
- Cardiovascular Research
- Pharmacology
Background:
- Peripheral artery disease (PAD) patients face high cardiovascular event risk.
- Anti-thrombotic therapy is crucial for secondary prevention in PAD.
- Current guidelines recommend single antiplatelet therapy, with limited evidence for dual antiplatelet therapy post-revascularization.
Purpose of the Study:
- To evaluate the efficacy and safety of combined rivaroxaban and aspirin therapy after peripheral revascularization in PAD patients.
- To assess the impact of this combination on Major Adverse Cardiac Events (MACE) and Major Adverse Limb Events (MALE).
Main Methods:
- The VOYAGER PAD study investigates the concept tested in the COMPASS trial.
- Patients undergo peripheral revascularization (endovascular or surgical).
- Treatment arms compare aspirin alone versus aspirin plus low-dose rivaroxaban.
Main Results:
- The COMPASS study demonstrated reduced MACE and MALE with rivaroxaban plus aspirin versus aspirin alone, but with increased gastrointestinal bleeding.
- VOYAGER PAD specifically tests this strategy in the post-peripheral revascularization setting.
- Results are pending for the VOYAGER PAD study.
Conclusions:
- The VOYAGER PAD study aims to provide critical evidence on optimal anti-thrombotic strategies following peripheral revascularization.
- Findings could influence clinical practice for PAD management and secondary prevention.
- Balancing efficacy in reducing thrombotic events against bleeding risk is key.
Abstract:
Patients with peripheral artery disease are at high-risk for cardiovascular events. Anti-thrombotic treatment is very important for secondary prevention. In symptomatic patients single antiplatelet therapy with clopidogrel or Aspirin is recommended. After peripheral revascularisation transient dual antiplatelet therapy is widely used although there is only little evidence. Following peripheral bypass surgery most patients are treated with single antiplatelet therapy, in some cases (prostetic bypass grafts) dual antiplated therapy can be useful and selected patients with complex venous grafts might profit from anticoagulation with vitamin K antagonists.The recent publication of the COMPASS (Cardiovascular OutcoMes for People Using Anticoagulation StrategieS) study showed relevant reduction of MACE (Major Adverse Cariac Events) and MALE (Major Adverse Limb Events) for the combined therapy of rivaroxaban 2 × 2,5 mg compared to Aspirin 100 mg with increased risk for gastrointestinal bleeding. In the current VOYAGER PAD (Vascular Outcomes Study of Aspirin along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) study this concept is tested after peripheral revascularisation.
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