The COMPASS trial demonstrated that low-dose rivaroxaban with aspirin improved cardiovascular outcomes in patients with atherosclerotic cardiovascular disease (ASCVD), a condition caused by plaque buildup on the artery walls. In a recent publication in Atherosclerosis, researchers evaluated the possible clinical implications of this therapeutic strategy in a population of Canadian patients with ASCVD.
The study population was a retrospective cohort of adults with ASCVD assembled from healthcare administrative databases in the province of Alberta, Canada. The researchers identified a total of 232,460 patients who received long-term follow-up exceeding 5 years. Of those identified, 37% met the eligibility criteria of the COMPASS trial, 27% did not meet the inclusion criteria, and 36% met the inclusion criteria but had an exclusion criterion. The primary outcome of major adverse cardiovascular events (MACE), including cardiovascular death, stroke, or myocardial infarction (heart attack), was assessed and classified based on eligibility criteria for the COMPASS trial. Over a median follow-up period of 7.8 years, MACE occurred in 53,081 (22.8%) patients, with the highest rates in the exclusion group (5.9 per 100 person-years), followed by the eligible group (3.1 per 100 person-years), and those who did not meet inclusion criteria (1.4 per 100 person-years).
Within a population of 3.3 million adults, the researchers identified approximately 20,000 new cases of ASCVD diagnosed yearly, with roughly 40% eligible for the addition of low-dose rivaroxaban with aspirin. Overall, the predicted net clinical benefit of this treatment therapy in the eligible group was 5.6 fewer events per 1000 person-years. These findings suggest that implementing low-dose rivaroxaban with aspirin could potentially result in a significant reduction in cardiovascular morbidity and death. The researchers emphasize the theoretical nature of these results and recommend further investigation of the treatment strategy to better understand the overall clinical benefits and risks.
This publication was co-authored by the CVC’s Robert Welsh, MD, Pishoy Gouda, MB, BCh, BAO, MSc (Interventional Cardiology Fellow), Doug Dover, PhD, Kevin Bainey, MD, MSc, Finlay McAlister, MD, MSc, and Padma Kaul, PhD.
