In patients with stable coronary or peripheral artery disease, diabetes increases the benefit of combining low doses of rivaroxaban and aspirin vs. aspirin alone. 

This analysis was pre-specified in the COMPASS protocol and was presented virtually for the ACC 2020 and simultaneously published in Circulation.

Patients with diabetes, showed numerically greater reduction in terms of the absolute end point, combined MACE (cardiovascular death, MI or stroke) and all cause death, while increased bleeding, caused by adding rivaroxaban, was not higher vs. the non-diabetic. 

The COMPASS originally included 27395 patients with stable coronary or peripheral artery disease, or both. It was presented at ESC 2017 and had showed combining 2,5 mg of rivaroxaban twice a day plus 100 mg of aspirin a day, reduced the combined end point of MACE events and mortality while increasing bleeding vs. aspirin alone. 

Read also: COMPASS: A New Place for Rivaroxaban in Chronic Ischemic Heart Disease.

For the present analysis presented at ACC 2020, the focus was on 6922 diabetic patients initially enrolled vs. 11356 non-diabetic. 

Diabetes did not affect end points significantly, but given the higher risk of baseline events, reduction was numerically greater vs the general population. Bleeding events increased equally in diabetic and non-diabetic patients, as opposed to thrombotic events. 

For now, this increase in bleeding and the economic cost of the drug balance the pros and cons of rivaroxaban.

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Original Title: The role of combination antiplatelet and anticoagulation therapy in diabetes and cardiovascular disease: insights from the COMPASS trial. 

Reference: Bhatt DL et al. Circulation. 2020; online before print y presentado simultáneamente en el ACC 2020 en forma virtual.

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