Virtual ACC 2020 | VOYAGER PAD: Rivaroxaban Superior to Aspirin in Preventing Events

In patients with peripheral artery disease undergoing revascularization, the combination of rivaroxaban (Xarelto) and low doses of aspirin are superior to aspirin alone in the prevention of acute low limb ischemic events, amputation, cardiovascular events and strokes. The outcomes of VOYAGER PAD add to the COMPASS outcomes, showing the combination of therapies can benefit risk subgroups. 

ACC 2020 Virtual | VOYAGER PAD: el rivaroxaban supera a la aspirina en prevenir eventos

Even a long time after an intervention, patients with peripheral artery disease present 4 times higher risk of acute ischemia vs patients that have never been revascularized. This higher risk will never return to baseline levels.

The VOYAGER PAD presented virtually at ACC 2020 and simultaneously published in NEJM showed rivaroxaban twice a day in addition to aspirin showed fewer events of low limb ischemia compared against aspirin alone. This difference was already apparent 3 months after randomization.  

To arrive to these results, researchers randomized 6564 patients with symptomatic peripheral artery disease who had already been revascularized within 10 days prior to therapy with 2.5 mg c/12 hrs. plus aspirin 100 mg/day vs placebo plus aspirin 100 mg/day.


Read also: Virtual ACC 2020 | More data from ISCHEMIA: Women with More Symptoms but Less Ischemia.


Most patients were revascularized for pain when walking and only one fourth for critical ischemia. Two thirds had endovascular treatment and one third open surgery.

Clopidogrel was used at operator discretion in half the population.

At 28 month mean follow-up, the incidence of primary end point (acute lower limb ischemia, amputation for vascular reason, infarction, ischemic stroke or cardiovascular death) resulted 17.3% in the rivaroxaban/aspirin group vs 19.9% in the placebo/aspirin group (HR 0.85; CI 95% 0.76-0.96). This equals 1.5% absolute risk reduction at 6 months with a necessary number to treat (NNT) of 65. Over time, the absolute reduction increases and the NNT decreases.


Read also: Virtual ACC 2020 | COMPASS Sub-Analysis: Diabetes Increases the Benefit of Rivaroxaban Combined with AAS.


All primary end point components saw a reduction, except for death.

Major bleeding rate in the rivaroxaban group was 5.9% vs 4.1% in the aspirin group at 3-year follow-up, which represents an absolute increase of 0.6% a year.

voyager-pad

Original Title: Rivaroxaban in peripheral artery disease after revascularization.

Reference: Bonaca MP et al. N Engl J Med. 2020; Epub ahead of print y presentado en forma virtual en al ACC 2020.

More articles by this author

TCT 2024 | SIRONA: Randomized Study Comparing Sirolimus-Coated vs Paclitaxel-Coated Balloon Angioplasty in Femoropopliteal Disease

This prospective, randomized, multicenter, investigator-initiated non-inferiority study compared the use of sirolimus-coated balloon (MagicTouch) vs paclitaxel-coated balloon in endovascular treatment.  The primary objective was to...

TCT 2024 | PEERLESS: Mechanical Thrombectomy with FlowTriever vs Catheter-Directed Thrombolysis in Intermediate Risk PTE

Pulmonary embolism (PE) continues to be the third cause of cardiovascular mortality. The current clinical guidelines recommend anticoagulation in intermediate risk patients presenting right...

STEACS and the Use of Bivalirudin vs. Heparin: In Search of BRIGHT-4 Outcomes

Various studies and registries have previously shown the impact of post-percutaneous coronary intervention (PCI) complications on the survival of patients with ST-segment elevation acute...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...