The COMPASS trial studied rivaroxaban in stable coronary artery disease or peripheral artery disease. Its key finding was:
- A Rivaroxaban 20 mg once daily was superior to aspirin alone in preventing MACE
- B Rivaroxaban 2.5 mg twice daily PLUS aspirin 100 mg daily reduced MACE and limb ischaemia versus aspirin alone, at the cost of increased major (but not fatal) bleeding ✓
- C Full-dose rivaroxaban alone was non-inferior to aspirin plus clopidogrel
- D Rivaroxaban showed no benefit in peripheral artery disease subgroup
Explanation
The COMPASS trial enrolled >27,000 patients with stable CAD or PAD. The vascular dose of rivaroxaban (2.5 mg twice daily — too low for anticoagulation, sufficient for anti-thrombotic effect) combined with aspirin 100 mg daily significantly reduced the composite of MI, stroke, and CV death by 24% compared to aspirin alone. In the PAD subgroup, major adverse limb events (including amputation) were also significantly reduced. There was a significant increase in major (mainly GI) bleeding but not fatal or intracranial bleeding. This regimen is approved and used in selected stable atherosclerotic disease patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.