[Combined Antithrombotic Therapy in Patients with a Stable Atherosclerotic Cardiovascular Diseases: What Direction...

Area of Science:

• Cardiology
• Vascular Medicine
• Pharmacology

Background:

• Stable ischemic heart disease (IHD) and peripheral artery disease (PAD) patients face significant residual cardiovascular complication (CVC) risk despite current antiplatelet therapies.
• Atherothrombosis prevention strategies require further optimization, with coagulation pathways offering potential targets.
• Existing secondary prevention guidelines present challenges in practical application.

Purpose of the Study:

• To evaluate the efficacy and safety of adding rivaroxaban to aspirin for secondary prevention in patients with IHD and/or PAD.
• To assess the impact of combination antithrombotic therapy on cardiovascular outcomes and bleeding events.
• To identify patient subgroups who may benefit most from this intensified prevention strategy.

Main Methods:

• The study analyzed data from the COMPASS trial, comparing aspirin monotherapy to aspirin plus rivaroxaban (2.5 mg twice daily).
• Outcomes included major adverse cardiovascular events (MACE), all-cause death, and bleeding events (major, fatal, intracranial).
• Subgroup analyses focused on patients with specific risk profiles, including those with PAD and high CVC risk.

Main Results:

• Combination therapy with rivaroxaban and aspirin significantly reduced the risk of cardiovascular death, myocardial infarction, stroke, and all-cause death compared to aspirin alone.
• Major bleeding risk was increased with combination therapy, but fatal or intracranial bleeding did not significantly increase.
• Peripheral artery disease patients experienced a reduced risk of severe lower limb ischemic events, including amputations.

Conclusions:

• Adding low-dose rivaroxaban to aspirin provides superior secondary prevention for patients with stable atherosclerotic disease (IHD/PAD), significantly lowering CVC risk.
• The benefits of combination therapy, particularly in reducing ischemic limb events, outweigh the increased risk of major bleeding in high-risk patients.
• This strategy appears most beneficial for stable atherosclerotic patients at high risk for severe CVC, without a prohibitive increase in bleeding risk.