Physicians' Academy for Cardiovascular Education
NOAC plus aspirin reduces CV events in stable CAD and/or PAD patients with and without diabetes

NOAC plus aspirin reduces CV events in stable CAD and/or PAD patients with and without diabetes

News - Mar. 29, 2020

The Role Of Combination Antiplatelet And Anticoagulation Therapy In Diabetes And Cardiovascular Disease: Insights From The Compass Trial

Presented at ACC.20 by Deepak Bhatt, MD (Boston, MA, USA)

Introduction and methods

Patients with CAD or PAD and diabetes are at high risk of CV events. One potential way to address residual CV risk is dual pathway inhibition (DPI), which combines antiplatelet therapy with anticoagulation therapy.

This pre-specified analysis of the COMPASS trial specifically examined the effect of DPI in 6,922 patients with diabetes at baseline and 11,356 patients without diabetes. All patients had stable CAD and/or PAD. Patients were randomly assigned to receive either low-dose rivaroxaban (2.5mg twice daily) plus aspirin (100mg daily) or placebo plus aspirin (100mg daily).

The primary efficacy endpoint was CV death, MI or stroke. Secondary efficacy endpoints consisted of all-cause mortality and the composite endpoint of CV Death, MI, Stroke, MALE, or major vascular amputation. The primary safety endpoint was modified ISTH criteria -major bleeding. The prespecified net clinical benefit consisted of CV death, MI, stroke, fatal bleeding, and symptomatic bleeding into a critical organ.

Main results


Low-dose rivaroxaban plus aspirin reduced the primary endpoint in patients with CAD and/or PAD, irrespective of the presence or absence of diabetes, compared to aspirin alone. The absolute risk reductions were numerically larger is patients with diabetes compared to those without diabetes. A significant increase in major bleeding was observed in the low-dose rivaroxaban plus aspirin arm compared to the aspirin alone arm for those with and without diabetes, but no difference between treatment arms was found for intracranial or fatal bleeding. The net clinical benefit was reduced in the rivaroxaban plus aspirin arm in patients with and without diabetes, and was numerically greater in those with diabetes.

- Our coverage of ACC.20 is based on the information provided during the congress –

The results were published simultaneously in Circulation Watch the video by prof. Bhatt

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