ESC 2020 | Rivaroxaban Might Reduce Cardiac Cerebral and Peripheral Events

Adding rivaroxaban to the standard treatment might reduce events incidence in lower limbs, heart, and brain, in patients with peripheral vascular disease undergoing revascularization.  

These new data resulted from the analysis of the VOYAGER PAD subgroups and were presented at the virtual ESC 2020.

The COMPASS study had reached similar conclusions using 2.5 mg rivaroxaban twice a day + aspirin vs. aspirin monotherapy. 

The VOYAGER PAD took rivaroxaban’s potential to the next level by showing events reduction in lower limbs, even in patients with no known coronary artery disease (CAD). 

In patients with known CAD (and therefore with higher baseline risk) cardio and cerebrovascular events reduction were within expectations. 

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Rivaroxaban is an option in select patients with peripheral and coronary disease (like the COMPASS population) and in those with recent lower limb revascularization with concomitant CAD. 

To reach these conclusions, the VOYAGER PAD included 6564 patients with symptomatic peripheral vascular disease (PAD) receiving revascularization up to 10 days before. Patients were randomized to 2.5 mg rivaroxaban twice a day vs. placebo, and both branches received 100 mg of aspirin. 

The sub-analysis focuses on 2067 patients from the study that had concomitant CAD. 

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The end point (a combination of acute limb ischemia, major amputation of vascular etiology, ischemic stroke, infarction and cardiovascular death) occurred in 18.9% of patients receiving rivaroxaban vs 24.3% in the placebo group, at 3 year followup (HR 0.78; CI 95% 0.64-0.95).

For patients with no CAD, the benefit showed a trend, but did not reach significance (16.1% vs 17.9%; HR 0.89; CI 95% 0.77-1.04).

Original Title: Efficacy and safety of rivaroxaban in patients with PAD undergoing revascularization with and without coronary artery disease.

Reference: Hiatt W, et al. Presentado en el congreso de la ESC 2020.

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