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Rivaroxaban Plus Aspirin in Cardiovascular Disease

Explore the effectiveness of combining rivaroxaban and aspirin vs aspirin alone for secondary cardiovascular prevention in stable patients with atherosclerotic vascular disease.

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Rivaroxaban Plus Aspirin in Cardiovascular Disease

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  1. Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. NEJM 2017 COMPASS: CardiovascularOutcomes for People Using Anticoagulation Strategies • Low dose NOAC plus aspirin improve outcomes in stable cardiovascular disease compared with aspirin alone

  2. COMPASS: Background and Objective • Background • 5-10% of patients with cardiovascular disease suffer recurrent events, although they receive secondary prevention therapies • Anticoagulation is not a recommended routine therapy for these patients • Studyobjective • The COMPASS study was designed to assess, whether rivaroxaban alone or in combination with aspirin is more effective than aspirin alone for secondary cardiovascular prevention. Eikelboom JW, et al. NEJM 2017

  3. COMPASS: Study design • Median follow-up: 23 months • Primary endpoint: compositeof non-fatal MI, non-fatal stroke, and CV death The study was stopped due tosuperiorityoftherivaroxaban plus aspiringroup AVD: atherosclerotic vascular disease; TD: twice daily; OD: once daily; MI: myocardial infarction; CV: cardiovascular; Eikelboom JW, et al. NEJM 2017

  4. COMPASS: Main results (1/2) Primary outcome: CV death, stroke, MI Major bleedings CV: cardiovascular; MI: myocardial infarction; R: rivaroxaban; A: aspirin; HR: hazard ratio; CI: confidence interval; Eikelboom JW, et al. NEJM 2017

  5. COMPASS: Main results (2/2) Net clinical benefit: CV death, stroke, MI, major bleedings CV: cardiovascular; MI: myocardial infarction; R: rivaroxaban; A: aspirin; HR: hazard ratio; CI: confidence interval; Eikelboom JW, et al. NEJM 2017

  6. COMPASS: Conclusions • Rivaroxaban 2.5 mg twicedaily plus aspirin 100 mg oncedailyreducetheriskof CV death, stroke, andmyocardialinfarction, andincreasemajorbleedingscomparedwithaspirinalone, thus, providing a netclinicalbenefitforstablepatientswithatheroscleroticvasculardisease. • Rivaroxabanmonotherapyleadstolesscardiovascularoutcomes, andtosignificantlyhigherratesofmajorbleeding, comparedwithaspirinmonotherapy. Eikelboom JW, et al. NEJM 2017

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