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Rivaroxaban, Aspirin, or Both to Prevent Early Coronary Bypass Graft Occlusion: The COMPASS-CABG Study

Andre Lamy1, John Eikelboom2, Tej Sheth2

  • 1Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; CADENCE Research Group, Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

Journal of the American College of Cardiology
|January 19, 2019
PubMed

Insights

Rivaroxaban plus aspirin did not prevent graft failure after coronary artery bypass graft surgery. However, the combination therapy showed a similar reduction in major adverse cardiovascular events as seen in the COMPASS trial.

Area of Science:

  • Cardiovascular Surgery
  • Pharmacology
  • Clinical Trials

Background:

  • Patients undergoing coronary artery bypass graft (CABG) surgery face risks of early graft failure, myocardial infarction, and death.
  • The COMPASS trial demonstrated rivaroxaban plus aspirin reduced major adverse cardiovascular events (MACE) compared to aspirin alone.
  • Rivaroxaban 5 mg twice daily monotherapy did not significantly reduce MACE in the COMPASS trial.

Purpose of the Study:

  • To evaluate the efficacy of COMPASS trial treatments in preventing graft failure and MACE post-CABG.
  • To compare rivaroxaban plus aspirin, rivaroxaban alone, and aspirin alone in a CABG patient substudy.

Main Methods:

  • A substudy of 1,448 COMPASS trial patients randomized 4-14 days post-CABG.
  • Treatment groups included rivaroxaban plus aspirin, rivaroxaban alone, or aspirin alone.
  • Primary outcome was graft failure assessed by CT angiogram at 1 year; MACE was a secondary outcome.

Main Results:

  • Neither rivaroxaban plus aspirin nor rivaroxaban alone reduced graft failure rates compared to aspirin alone.
  • The combination of rivaroxaban and aspirin showed a trend towards fewer MACE compared to aspirin alone (HR: 0.69; p=0.34).
  • Rivaroxaban alone did not significantly alter MACE rates compared to aspirin alone; no fatal bleeding or tamponade occurred within 30 days.

Conclusions:

  • Rivaroxaban 2.5 mg twice daily plus aspirin or rivaroxaban 5 mg twice daily alone did not reduce graft failure post-CABG.
  • The combination of rivaroxaban and aspirin demonstrated similar MACE reductions as observed in the broader COMPASS trial.
  • These findings suggest a potential role for combination therapy in managing cardiovascular risk after CABG, warranting further investigation.
Abstract

Keywords:
anticoagulationcardiac surgerycoronary artery diseasegraft failures

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