COMPASS

Cardiovascular Outcomes for People Using Anticoagulation Strategies

Patient / Population Intervention / Exposure Comparison Outcome

In 27,395 patients with stable coronary or peripheral artery disease, low-dose rivaroxaban plus aspirin reduced cardiovascular death, stroke or MI compared with aspirin alone.

27,395

Design

Double-blind RCT, stopped early

Endpoint

CV death, stroke or MI

Relevance

Result4.1 % vs 5.4 % (HR 0.76); more major bleeding; all-cause mortality reduced.

Eikelboom JW, et al. N Engl J Med. 2017;377(14):1319-1330. 10.1056/NEJMoa1709118

Discussion & critique

Dual-pathway inhibition for chronic atherosclerosis. The absolute benefit is modest and bleeding is increased, so it targets higher-ischaemic, lower-bleeding-risk patients.