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Stroke Outcomes in the COMPASS Trial.
Mukul Sharma1, Robert G Hart1, Stuart J Connolly1
1McMaster University/Population Health Research Institute, Hamilton, Canada (M.S., R.G.H., S.J.C., J.B., O.S., K.K.H.N., L.C., S.Y., J.W.E.).
Circulation
|January 23, 2019
Summary
The combination of rivaroxaban and aspirin significantly reduced strokes in patients with atherosclerosis compared to aspirin alone. This combination therapy offers a new antithrombotic strategy for stroke prevention.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Neurology
Background:
- The COMPASS trial investigated antithrombotic strategies for patients with stable coronary artery or peripheral artery disease.
- Stroke reduction was a key outcome measure in the trial.
- Previous analyses showed a significant benefit of rivaroxaban plus aspirin over aspirin alone.
Purpose of the Study:
- To present detailed analyses of stroke by type, predictors, and antithrombotic effects in key subgroups from the COMPASS trial.
- To evaluate the efficacy of rivaroxaban plus aspirin versus aspirin alone in preventing different types of strokes.
- To identify independent predictors of stroke in patients with established atherosclerotic disease.
Main Methods:
- A randomized trial involving patients with stable coronary artery or peripheral artery disease.
- Three treatment arms: aspirin 100 mg once daily, rivaroxaban 5 mg twice daily, and rivaroxaban 2.5 mg twice daily plus aspirin.
- Exclusion criteria included need for anticoagulation, recent stroke, lacunar stroke history, or intracerebral hemorrhage.
Main Results:
- The combination of rivaroxaban plus aspirin significantly reduced overall stroke occurrence compared to aspirin alone (HR, 0.58; P<0.0001).
- Ischemic/uncertain strokes were reduced by nearly half with the combination therapy (HR, 0.51; P<0.0001).
- Fatal and disabling strokes were also decreased by the combination (HR, 0.58; P=0.01).
- Prior stroke was the strongest independent predictor of incident stroke (HR, 3.63; P<0.0001).
- The benefit of the combination was consistent across high-stroke-risk subgroups, including those with prior stroke.
Conclusions:
- Low-dose rivaroxaban plus aspirin represents a significant advancement in antithrombotic therapy.
- This combination is an effective option for both primary and secondary stroke prevention in patients with clinical atherosclerosis.
- The findings support the use of rivaroxaban plus aspirin in specific patient populations at high risk for stroke.
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