[Antithrombotic therapy after acute coronary syndromes: is it possible to identify the PEGASUS and COMPASS patient?]

Area of Science:

• Cardiovascular Medicine
• Clinical Trials
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) is standard after acute coronary syndrome (ACS).
• Extended DAPT duration and alternative antithrombotic strategies are debated post-ACS.
• The PEGASUS-TIMI 54 and COMPASS trials provide key data on long-term treatment.

Purpose of the Study:

• To compare the patient profiles and clinical implications of the PEGASUS-TIMI 54 and COMPASS trials.
• To analyze strategies for extended antithrombotic therapy following an initial year of DAPT after ACS.

Main Methods:

• Review of study designs, inclusion/exclusion criteria for PEGASUS-TIMI 54 and COMPASS.
• Analysis of key subanalyses and recently published real-world evidence.
• Comparative assessment of patient characteristics and treatment outcomes.

Main Results:

• PEGASUS-TIMI 54 evaluated prolonged DAPT versus aspirin alone.
• COMPASS evaluated aspirin plus low-dose rivaroxaban versus aspirin alone.
• Both trials addressed long-term secondary prevention in high-vascular-risk patients.

Conclusions:

• Understanding patient profiles from PEGASUS and COMPASS informs clinical decisions on long-term antithrombotic therapy.
• The choice between prolonged DAPT and aspirin with rivaroxaban depends on individual patient risk profiles and bleeding considerations.