COMPASS for Vascular Surgeons: Practical Considerations

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Pharmacology

Background:

• Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis.
• Patients with PAD are at high risk for adverse cardiovascular and limb events.
• The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial evaluated antithrombotic strategies in stable atherosclerotic vascular disease.

Purpose of the Study:

• To provide a practical framework for applying COMPASS trial findings to patients with PAD.
• To guide clinicians in utilizing data from the COMPASS trial for PAD management.
• To identify patient subgroups within PAD who may benefit from intensified antithrombotic therapy.

Main Methods:

• Analysis of data from the COMPASS trial, focusing on patients with PAD.
• Identification of baseline characteristics associated with increased risk of major adverse limb events.
• Evaluation of the efficacy and safety of low-dose rivaroxaban plus aspirin versus aspirin alone in PAD patients.

Main Results:

• Low-dose rivaroxaban (2.5 mg BID) plus daily aspirin demonstrated superiority over aspirin alone in reducing major adverse cardiovascular, cerebrovascular, and limb events in PAD patients.
• The combination therapy was associated with an increased risk of major bleeding.
• Critical limb ischemia, prior amputation, and history of peripheral revascularization were independent predictors of major adverse limb events.

Conclusions:

• Intensified antithrombotic therapy with low-dose rivaroxaban and aspirin should be considered for PAD patients at high risk for ischemic or limb events, provided their bleeding risk is low.
• A practical approach is presented to aid clinicians in integrating COMPASS trial evidence into clinical practice for PAD management.
• Risk stratification based on clinical factors is crucial for optimizing the use of combination antithrombotic therapy in PAD.