COMPASS-PCI: Rivaroxaban Plus Aspirin Lowers MACE Better Than Aspirin Alone in Those With Prior PCI

Highlights

• The COMPASS trial showed that dual pathway inhibition with rivaroxaban plus aspirin was better at reducing major cardiovascular endpoints than aspirin alone.
• This study looked at outcomes in those with prior PCI procedures, with a men of 5.4 from PCI procedure to study randomization.
• The results indicated that the dual pathway inhibition was also consistently more effective at reducing major adverse cardiovascular events than aspirin alone, at a cost of increased major bleeding.

Dual pathway inhibition with rivaroxaban and aspirin was more effective than aspirin alone in reducing cardiovascular outcomes in patients who have a common interventional procedure, new analysis results suggest.

“The Cardiovascular OutcoMes for People using Anticoagulation StrategieS (COMPASS) trial demonstrated dual pathway inhibition (DPI) with rivaroxaban 2.5 mg twice-daily plus aspirin 100 mg once-daily versus aspirin 100 mg once-daily reduced the primary major adverse cardiovascular event (MACE) outcome of cardiovascular death, myocardial infarction (MI), or stroke as well as mortality in patients with chronic coronary syndromes or peripheral arterial disease,” the authors wrote in their abstract Whether this remains true in patients with a history of percutaneous coronary intervention (PCI) is unknown.”

Published in Circulation, the results of the COMPASS-PCI study, designed as a pre-specified sub-group analysis of 16,560 patients with chronic syndrome who were randomized to either rivaroxaban 2.5 mg twice-daily plus aspirin 100 mg once-daily or to 100 mg once-daily of aspirin alone. Of those, 9,862 pad prior PCI, with an average time from PCI to randomization of 5.4 years.

The authors reported that rivaroxaban plus aspirin was associated with consistent reductions in MACE and in mortality compared with aspirin alone, regardless of prior PCI status (For PCI: 4.0% vs. 5.5%, HR=0.74, 95% CI 0.61 to 0.88; For No PCI: 4.4% vs. 5.7%, HR=0.76, 95% CI 0.61 to 0.94, P for interaction=0.85). It did, however, increase major bleeding. In patients with prior PCI, DPI also produced “consistent, robust reductions in MACE” regardless of time from prior PCI procedure and irrespective of prior MI.

“COMPASS-PCI found vascular -dose rivaroxaban and aspirin compared with aspirin alone reduced MACE and all-cause mortality (and CV mortality) with or without prior PCI,” author Kevin Bainey, MD, an interventional cardiologist and professor of medicine at the Mazankowski Alberta Heart Institute at the University of Alberta, told DocWire News. “These outcomes were consistent irrespective of time since last PCI (up to 10 years prior). In the right patient, we believe this anti-thombotic strategy should be strongly considered in prior PCI patients with chronic coronary syndromes (aka stable ischemic heart disease).”