Total Ischemic Event Reduction With Rivaroxaban After Peripheral Arterial Revascularization in the VOYAGER PAD Trial
Rupert M Bauersachs1, Michael Szarek2, Marianne Brodmann3
1CCB-Cardiovascular Center Bethanien, Frankfurt, Germany; Center for Thrombosis and Hemostasis, University of Mainz, Mainz, Germany.
Journal of the American College of Cardiology
|May 19, 2021
Summary
Rivaroxaban significantly reduced the total burden of vascular events in patients with peripheral artery disease (PAD) undergoing lower extremity revascularization (LER). This anticoagulant therapy offers a substantial benefit beyond preventing first-time events.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Pharmacology
Background:
- Patients with peripheral artery disease (PAD) undergoing lower extremity revascularization (LER) face a high risk of adverse vascular events.
- The VOYAGER PAD trial showed rivaroxaban (2.5 mg twice daily) reduced first events by 15%, but its effect on total events was unknown.
Purpose of the Study:
- To assess the total burden of vascular events post-LER in PAD patients.
- To evaluate the efficacy of low-dose rivaroxaban in reducing all vascular events, not just the first occurrence.
Main Methods:
- Analysis of the VOYAGER PAD trial data, including first and subsequent vascular events.
- Comparison of rivaroxaban plus aspirin versus aspirin alone.
- Utilized marginal proportional hazards models to estimate hazard ratios for event reduction.
Main Results:
- Rivaroxaban significantly reduced total primary endpoint events (HR: 0.86; P = 0.02) and total vascular events (HR: 0.86; P = 0.003).
- Over 3 years, rivaroxaban use avoided an estimated 4.4 primary and 12.5 vascular events per 100 participants.
- The study included 6,564 randomized events, with 4,714 total vascular events analyzed.
Conclusions:
- Patients with symptomatic PAD undergoing LER experience a high total burden of vascular events.
- Low-dose rivaroxaban significantly reduces this total event burden, demonstrating its broad efficacy.
- Total event reduction is a valuable metric for assessing rivaroxaban's effectiveness in this high-risk population.
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