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Reducing residual thrombotic risk in patients with peripheral artery disease: impact of the COMPASS trial

José Luis Hernández1, Francisco S Lozano2, Vincent Riambau3

  • 1Internal Medicine Department, Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain.

Drugs in Context
|July 24, 2020
PubMed

Insights

Patients with peripheral artery disease (PAD) face high risks for cardiovascular and limb events. Combining rivaroxaban with aspirin significantly reduces these major adverse events, offering comprehensive protection.

Area of Science:

  • Vascular Medicine
  • Cardiology
  • Pharmacology

Background:

  • Peripheral artery disease (PAD) patients have elevated risks for major adverse cardiovascular events (MACE) and major adverse limb events (MALE).
  • Standard antiplatelet therapies inadequately mitigate recurrent thrombotic events in PAD.
  • Atherosclerosis in PAD involves platelet activation and coagulation, with Factor Xa playing a crucial role.

Purpose of the Study:

  • To evaluate the efficacy of a comprehensive antithrombotic strategy in reducing vascular risks in PAD patients.
  • To assess the impact of rivaroxaban plus aspirin compared to aspirin alone on MACE and MALE.

Main Methods:

  • The study analyzed data from the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial.
  • Patients with stable atherosclerotic vascular disease received either rivaroxaban plus aspirin or aspirin alone.
  • Outcomes included MACE, MALE (including major amputation), and fatal or critical organ bleeding.

Main Results:

  • The rivaroxaban plus aspirin strategy significantly reduced the risk of both CV and limb outcomes.
  • A 28% reduction in the net clinical benefit outcome (MACE, MALE, and major bleeding) was observed (HR: 0.72; 95% CI: 0.59-0.87).
  • The combined therapy demonstrated a favorable safety profile.

Conclusions:

  • Rivaroxaban plus aspirin provides comprehensive protection against major vascular events in high-risk PAD patients.
  • This strategy should be considered for managing PAD to reduce residual vascular risk.
  • Addressing both platelet activation and coagulation is key for effective PAD management.

Keywords:
COMPASSperipheral artery diseaseresidual riskrivaroxaban

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