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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
PubMed

Insights

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.
Abstract

Keywords:
aspirinatherosclerosisprevention and controlrandomized controlled trialrivaroxabanstroke

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