Reducing residual thrombotic risk in patients with peripheral artery disease: impact of the COMPASS trial

Article Details

Authors
José Luis Hernández MD, PhD, Francisco S Lozano MD, PhD, Vincent Riambau MD, PhD, Manuel Almendro-Delia MD, PhD, Juan Cosín-Sales MD, PhD, Sergi Bellmunt-Montoya MD, PhD, Javier Garcia-Alegria MD, PhD, Xavier Garcia-Moll MD, FESC, FACC, Juan José Gomez-Doblas MD, PhD, José R Gonzalez-Juanatey MD, PhD, Carmen Suarez Fernández MD

Article Type
Review

DOI
10.7573/dic.2020-5-5

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Abstract

Patients with peripheral artery disease (PAD) are at a high risk not only for the classical cardiovascular (CV) outcomes (major adverse cardiovascular events; MACE) but also for vascular limb events (major adverse limb events; MALE). Therefore, a comprehensive approach for these patients should include both goals. However, the traditional antithrombotic approach with only antiplatelet agents (single or dual antiplatelet therapy) does not sufficiently reduce the risk of recurrent thrombotic events. Importantly, the underlying cause of atherosclerosis in patients with PAD implies both platelet activation and the initiation and promotion of coagulation cascade, in which Factor Xa plays a key role. Therefore, to reduce residual vascular risk, it is necessary to address both targets. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial that included patients with stable atherosclerotic vascular disease, the rivaroxaban plus aspirin strategy (versus aspirin) markedly reduced the risk of both CV and limb outcomes, and related complications, with a good safety profile. In fact, the net clinical benefit outcome composed of MACE; MALE, including major amputation, and fatal or critical organ bleeding was significantly reduced by 28% with the COMPASS strategy, (hazard ratio: 0.72; 95% confidence interval: 0.59–0.87). Therefore, the rivaroxaban plus aspirin approach provides comprehensive protection and should be considered for most patients with PAD at high risk of such events.

Keywords: COMPASS, peripheral artery disease, residual risk, rivaroxaban.

Citation: Hernández JL, Lozano FS, Riambau V, Almendro-Delia M, Cosín- Sales J, Bellmunt-Montoya S, Garcia-Alegria J, Garcia-Moll X, Gomez-Doblas JJ, Gonzalez-Juanatey JR, Suarez Fernández C. Reducing residual thrombotic risk in patients with peripheral artery disease: impact of the COMPASS trial. Drugs in Context 2020; 9: 2020-5-5. DOI: 10.7573/dic.2020-5-5

Contributions: All authors contributed equally to the preparation of this review. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: JLH reports consulting fees and/or lectures honoraria from Bayer, Daiichi Sankyo, Sanofi, Abbie, and AMGEN. FSL received compensation for advisory-board membership from Boehringer-Ingelheim, Bayer Health Care, Daiichi Sankyo, Rovi, and Sanofi-Aventis; and lectures fees from Bayer Health Care, Daiichi Sankyo, Glaxo Smith Kline, Leo Pharma, Menarini, Rovi, and Sanofi-Aventis. VR reports consulting fees from Bayer, Sanofi, and AstraZeneca. MAD reports consulting fees and/or lectures honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Eli Lilly, GlaxoSmithKline, Daiichi-Sankyo, Rovi Pharmaceuticals, and Sanofi Aventis, and grants support from AstraZeneca. JCS reports consulting fees and/or lectures honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, and Pfizer-BMS. SBM reports consulting fees from Bayer. JGA reports consulting fees and/or lectures honoraria from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, and Daiichi Sankyo. XGM reports consulting fees and/or lectures honoraria and/or advisory-board membership with Astra-Zeneca, Bayer, Boehringer-Ingelheim, Daiichi Sankyo, and Bristol-Myers Squibb/Pfizer. JJGD reports consulting fees and/or lectures honoraria from Bayer, Boehringer Ingelheim, AstraZeneca, and Daiichi Sankyo. JRGJ reports honoraria for lectures and advisory board from Bayer. CSF reports consulting fees and/or lectures honoraria from Bayer, Daiichi Sankyo, Pfizer-BMS and SBM. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/06/dic.2020-5-5-COI.pdf

Acknowledgements: Writing and editorial assistance was provided by Content Ed Net, Madrid, Spain.

Funding declaration: Writing and editorial assistance was funded by Bayer Hispania.

Copyright: Copyright © 2020 Hernández JL, Lozano FS, Riambau V, Almendro-Delia M, Cosín-Sales J, Bellmunt-Montoya S, Garcia-Alegria J, Garcia-Moll X, Gomez-Doblas JJ, Gonzalez-Juanatey JR, Suarez Fernández C. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Hernández JL, Lozano FS, Riambau V, Almendro-Delia M, Cosín-Sales J, Bellmunt-Montoya S, Garcia- Alegria J, Garcia-Moll X, Gomez-Doblas JJ, Gonzalez-Juanatey JR, Suarez Fernández C. https://doi.org/10.7573/dic.2020-5-5. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/reducing-residual-thrombotic-risk-in-patients-with-peripheral-artery-disease:-impact-of-the-compass-trial

Correspondence: José Luis Hernández, Hospital Universitario de Marqués de Valdecillas, Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain. hernandezjluis@gmail.com

Provenance: submitted; externally peer reviewed.

Submitted: 12 May 2020; Peer review comments to author: 20 May 2020; Revised manuscript received: 26 May 2020; Accepted: 28 May 2020; Publication date: 6 July 2020.

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