The COMPASS trial (NCT01776424) compared outcomes of subjects with chronic coronary artery disease (CAD) or peripheral artery disease (PAD) taking rivaroxaban plus aspirin with subjects taking aspirin alone. The primary outcome (a composite of myocardial infarction, stroke, or cardiovascular [CV] death) was decreased by 24% in the group taking rivaroxaban plus aspirin.
COMPASS investigators have just published a further analysis which reports the effects of rivaroxaban plus aspirin on overall and cause-specific mortality.
Effects on mortality
The COMPASS trial enrolled a total of 27,395 patients; of these, 9152 received rivaroxaban plus aspirin, and 9126 received aspirin alone. After a median follow-up period of 23 months, 313 (3.4%) patients in the combination therapy group and 378 (4.1%) patients in the aspirin-only group had died (hazard ratio [HR] 0.82; 95% confidence interval [CI] 0.71-0.96; P=0.01).
Investigators further examined outcomes according to CV deaths versus non-CV deaths. CV death was defined as death for which a definite non-CV cause was not identified. Non-CV death was defined as any death for which definite evidence of a primary non-CV cause existed. This analysis showed that, compared with aspirin alone, rivaroxaban plus aspirin reduced CV death (160 [1.7%] vs. 203 [2.2%]; HR 0.78; 95% CI 0.64-0.96; P=0.02), but it did not reduce non-CV death (HR 0.87; 95% CI 0.70-1.08; P=0.20). Furthermore, greater mortality benefit was noted in patients with increased baseline risk, including polyvascular disease, chronic kidney disease, and heart failure.
A greater reduction in mortality in patients with chronic CAD or PAD is achieved by combining rivaroxaban and aspirin than with aspirin alone. This reduction in mortality is driven primarily by a reduction in CV mortality and is greatest in key risk subgroups.
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Author: Kelly Schoonderwoerd
Original article: Eikelboom JW et al. J Am Coll Cardiol. 2021 Jul 6;78(1):14-23.