Physicians' Academy for Cardiovascular Education

Consistent efficacy and safety of DOAC in PAD patients with or without CAD

News - Aug. 30, 2020

VOYAGER PAD and concomitant coronary artery disease

Presented at the ESC congress 2020 by: William Hiatt, MD (Aurora, CO, USA)

Introduction and methods

Patients with peripheral artery disease (PAD) have an increased risk of major adverse cardiac events (MACE). This risk is even higher in PAD patients with concomitant coronary artery disease (CAD). Previous studies have also shown heterogeneity in response to therapy based on presence or absence of CAD in patients with PAD. The VOYAGER PAD trial randomized 6564 patients with symptomatic lower extremity PAD undergoing peripheral revascularization in a 1:1 ratio to receive either rivaroxaban 2.5 mg twice daily or placebo. All patients received aspirin. The objective of this subgroup analysis of the VOYAGER PAD trial was to evaluate whether presence of CAD is associated with increased risk of MACE and/or major adverse limb events (MALE) compared to absence of CAD in PAD patients. A second objective was to evaluate whether the safety and efficacy of rivaroxaban after lower extremity revascularization is consistent in PAD patients with and without CAD.

The primary outcome of the current subanalysis is the composite of acute limb ischemia, major amputation of vascular etiology, myocardial infarction, ischemic stroke or CV death.

Main results


Efficacy and safety of rivaroxaban 2.5 mg twice daily plus aspirin in PAD patients are consistent regardless of the absence or presence of CAD with no significant interactions.

- Our reporting is based on the information provided at the ESC congress -

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