Combination of NOAC with aspirin reduces overall and CV death in CAD and PAD
Mortality Benefit of Rivaroxaban Plus Aspirin in Patients With Chronic Coronary or Peripheral Artery DiseaseLiterature - Eikelboom JW, Bhatt DL, Fox KAA, et al. - J Am Coll Cardiol 2021;78:14-23, doi.org/10.1016/j.jacc.2021.04.083
Introduction and methods
The combination of 2.5 mg rivaroxaban and 100 mg aspirin compared with aspirin alone resulted in a 24% reduction of the primary outcome, a composite end point of CV death, stroke, or MI, in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD), as shown in the COMPASS trial [1-3]. The combination is now approved in >100 countries for prevention of CV death, stroke and MI in patients with CAD or PAD.
In this study, the effect of the combination of rivaroxaban and aspirin compared with aspirin alone was examined on the outcome of mortality, by cause and in risk subgroups.
COMPASS was a multicenter, international trial that randomized 18,278 CAD and PAD patients to the combination of 2.5 mg rivaroxaban twice daily and 100 mg aspirin once daily, 5 mg rivaroxaban twice daily or 100 mg aspirin once daily. Median follow-up was 23 months (IQR: 16-30 months).
- All-cause mortality was reduced by 18% in the group with the combination of rivaroxaban and aspirin compared with aspirin alone (HR 0.82; 95%CI:0.64-0.96, P=0.02), as was CV mortality (HR 0.78; 95%CI: 0.64-0.96, P=0.02). but non-CV death was not.
- There was a consistent pattern of reduced mortality with the combination compared to aspirin alone for causes of CV death, with the exception of death after heart failure.
- Relative risk reductions on mortality by combination compared to aspirin alone were consistent across risk subgroups (presence or absence of risk factor, or based on number of high-risk features [polyvascular disease, chronic kidney disease, mild or moderate heart failure and diabetes]), but absolute risk reductions were greatest in those with the highest risk.
The combination of rivaroxaban and aspirin reduced all-cause mortality and CV mortality, but not non-CV mortality, compared to aspirin alone in CAD and PAD patients in the COMPASS trial. Consistent reductions were seen for causes of CV mortality with the combination compared to aspirin alone and there were also consistent relative risk reductions across risk subgroups.