Long-Term Treatment with the Combination of Rivaroxaban and Aspirin in Patients with Chronic Coronary or Peripheral Artery Disease: Outcomes During the Open Label Extension of the COMPASS trial

Author:

Eikelboom John W1ORCID,Bosch Jacqueline12,Connolly Stuart J1,Tyrwitt Jessica1,Fox Keith A A3,Muehlhofer Eva4,Neumann Christoph4,Tasto Christoph4,Bangdiwala Shrikant I1,Diaz Rafael5ORCID,Alings Marco6ORCID,Dagenais Gilles R7,Leong Darryl P1,Lonn Eva M1ORCID,Avezum Alvaro8,Piegas Leopoldo S9ORCID,Widimsky Petr10,Parkhomenko Alexander N11,Bhatt Deepak L12ORCID,Branch Kelley R H13,Probstfield Jeffrey L14,Lopez-Jaramillo Patricio15,Rydén Lars16,Pogosova Nana17ORCID,Keltai Katalin18ORCID,Keltai Matyas18,Ertl Georg19,Stoerk Stefan19,Dans Antonio L20,Lanas Fernando21ORCID,Liang Yan22,Zhu Jun23ORCID,Torp-Pedersen Christian23,Maggioni Aldo P24ORCID,Commerford Patrick J25,Guzik Tomasz J2627,Vanassche Thomas28ORCID,Verhamme Peter28ORCID,O'Donnell Martin29,Tonkin Andrew M30,Varigos John D30,Vinereanu Dragos31,Felix Camillo32,Kim Jae-Hyung33,Ibrahim Khairul S34,Lewis Basil S35,Metsarinne Kaj P36,Aboyans Victor37,Steg Phillippe Gabriel38,Hori Masatsugu39,Kakkar Ajay40ORCID,Anand Sonia S1,Lamy Andre1,Sharma Mukul1,Yusuf Salim1

Affiliation:

1. Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton General Hospital , 237 Barton Street East, Hamilton Canada

2. School of Rehabilitation Science, McMaster University , Hamilton , Canada

3. Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK

4. Bayer AG Pharmaceuticals, Research & Development , Wuppertal , Germany

5. Estudios Clínicos Latino América and Instituto Cardiovascular de Rosario, Rosaria, Argentina

6. Division of Cardiology, Amphia ziekenhuis, Breda, Netherlands and Werkgroep Cardiologische centra Nederland (WCN) , Utrecht , the Netherlands

7. Institut universitaire de cardiologie et de pneumologie de Québec , Québec, QC , Canada

8. International Research Center, Hospital Alemão Oswaldo Cruz , São Paulo , Brazil

9. Research Institute, HCor, Hospital do Coração , São Paulo , Brazil

10. Cardiocenter, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University , Prague , Czech Republic

11. Emergency Cardiology Dept., National Scientific Center Institute of Cardiology , Kyiv , Ukraine

12. Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA

13. University of Washington Medical Centre , Division of Cardiology, Seattle , WA, USA

14. University of Washington SOM , Division of Cardiology/Department of Medicine, Seattle WA , USA

15. Research Institute, Fundación Oftalmológica de Santander (FOSCAL)—Bucaramanga , Bucaramanga , Colombia

16. Department of Medicine K2, Karolinska Institutet , Stockholm , Sweden

17. National Medical Research Center of Cardiology , Ministry of Healthcare of the Russian Federation, Moscow , Russia

18. Hungarian Cardiovascular Institute , Semmelweis University, Budapest , Hungary

19. Deutsches Zentrum für Herzinsuffizienz, Medizinische Klinik I, Universitätsklinikum Würzburg , Würzburg , Germany

20. College of Medicine, University of Philippines , Manila , Philippines

21. Universidad de La Frontera , Division of Cardiology, Internal Medicine Department, Temuco , Chile

22. Fuwai Hospital, CAMS & PUMC , Beijing , China

23. Dept of Clinical Medicine, University of Aalborg , Copenhagen , Denmark

24. ANMCO Research Center , Heart Care Foundation, Florence , Italy

25. Division of Cardiology, Department of Medicine, Groote Schuur Hospital and the University of Cape Town , Cape Town , South Africa

26. Department of Medicine, Jagiellonian University Medical College Krakow , Poland

27. Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow , UK

28. Department of Cardiovascular Sciences, University Hospitals Leuven , Leuven , Belgium

29. NUI Galway , Department of Medicine , Ireland

30. School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia

31. University of Medicine and Pharmacy Carol Davila; University and Emergency Hospital , Bucharest , Romania

32. Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE , Quito , Ecuador

33. Catholic University of Korea , Department of Medicine, Seoul , South Korea

34. Faculty of Medicine, Universiti Teknologi MARA , Selangor , Malaysia

35. Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion—Israel Institute of Technology , Haifa , Israel

36. Division of Medicine, Turku University Hospital and University of Turku , Turku , Finland

37. Department of Cardiology, Dupuytren University Hospital & INSERM 1094 , Limoges , France

38. Université de Paris, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris , Paris , France

39. Department of Oncocardiology, Osaka International Cancer Institute , Osaka , Japan

40. Thrombosis Research Institute and University College London , London , UK

Abstract

Abstract Aims To describe outcomes of patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD) enrolled in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) randomized trial who were treated with the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily during long-term open-label extension (LTOLE). Methods and results Of the 27 395 patients enrolled in COMPASS, 12 964 (mean age at baseline 67.2 years) from 455 sites in 32 countries were enrolled in LTOLE and treated with the combination of rivaroxaban and aspirin for a median of 374 additional days (range 1–1191 days). During LTOLE, the incident events per 100 patient years were as follows: for the primary outcome [cardiovascular death, stroke, or myocardial infarction (MI)] 2.35 [95% confidence interval (CI) 2.11–2.61], mortality 1.87 (1.65–2.10), stroke 0.62 (0.50–0.76), and MI 1.02 (0.86–1.19), with CIs that overlapped those seen during the randomized treatment phase with the combination of rivaroxaban and aspirin. The incidence rates for major and minor bleeding were 1.01 (0.86–1.19) and 2.49 (2.24–2.75), compared with 1.67 (1.48–1.87) and 5.11 (95% CI 4.77–5.47), respectively, during the randomized treatment phase with the combination. Conclusion In patients with chronic CAD and/or PAD, extended combination treatment for a median of 1 year and a maximum of 3 years was associated with incidence rates for efficacy and bleeding that were similar to or lower than those seen during the randomized treatment phase, without any new safety signals.

Funder

Bayer AG

BI

BMS

Janssen Pharmaceuticals

Merck

Pfizer

Sanofi

Servier

Bayer HealthCare

Kowa Pharmaceuticals

CSL Behring

Idorsia

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Cardiology and Cardiovascular Medicine

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2. Who may benefit from low-dose Rivaroxaban plus Aspirin? Practical implications for outpatients with cardiovascular disease;Polish Archives of Internal Medicine;2023-09-21

3. Low-dose rivaroxaban: can cardiovascular events be reduced?;European Heart Journal Supplements;2023-04-26

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