Title:Rivaroxaban versus Clopidogrel for Peripheral Artery Disease: A Clinico-Economic Approach of the COMPASS Trial
Volume: 24
Issue: 38
Author(s): Diamantis I. Tsilimigras, Demetrios Moris*, Georgios Karaolanis, Stavros K. Kakkos, Konstantinos Filis and Fragiska Sigala
Affiliation:
- Department of Surgery, Duke University Medical Center, Duke University, Durham, NC,United States
Keywords:
Rivaroxaban, clopidogrel, peripheral artery disease, COMPASS trial, atherosclerosis, cerebrovascular disease.
Abstract: Peripheral artery disease (PAD) is the third most common manifestation of atherosclerosis after coronary
artery (CAD) and cerebrovascular disease (CVD). People with PAD have plaque findings in other vascular
territories as well and, thus, are at increased risk of major adverse cardiovascular or cerebrovascular events
(MACCE), including myocardial infarction, and stroke. In that context, the COMPASS multicenter, randomized
controlled trial showed that the risk of MACCE was significantly reduced by 24% in the rivaroxaban plus aspirin
arm compared with aspirin alone (4.1% vs 5.4% respectively; HR: 0.76, 95% CI: 0.66 to 0.86). Interestingly, the
rivaroxaban/aspirin arm also showed a reduction in cardiovascular death (HR: 0.78; 95% CI: 0.64-0.96]) and allcause
mortality (HR: 0.82; 95% CI: 0.71-0.96) by 22% and 18%, respectively. Recently, the FDA approved the
use of the dual pathway approach, rivaroxaban 2.5 mg twice daily plus aspirin 75-100mg once daily, to reduce the
risk of major cardiovascular (CV) events, such as CV death, myocardial infarction and stroke, in people with
CAD as well as PAD. In comparing rivaroxaban plus aspirin versus aspirin alone, a preliminary economic analysis
showed that saving per patient was USD 462 for events and USD 220 for procedures with a total reduction of
USD 682 per participant in the US with the combination group (rivaroxaban plus aspirin). The data from COMPASS
trial suggest that low dose rivaroxaban plus aspirin may be a preferred treatment strategy in PAD patients
in whom the bleeding risk is deemed to be favourable.
