Reducing residual thrombotic risk in patients with peripheral artery disease : impact of the COMPASS trial
Hernández, José Luis (Instituto de Investigación Sanitaria Valdecilla (Santander, Cantàbria))
Lozano-Sánchez, Francisco Santiago (Hospital Clínico Universitario (Salamanca))
Riambau, Vincent (Hospital Clínic i Provincial de Barcelona)
Almendro-Delia, Manuel (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Cosín-Sales, Juan (Hospital Arnau de Vilanova (Lleida, Catalunya))
Bellmunt Montoya, Sergi (Hospital Universitari Vall d'Hebron)
Garcia-Alegria, Javier (Hospital Costa del Sol (Marbella))
Garcia-Moll, Xavier (Institut d'Investigació Biomèdica Sant Pau)
Gomez-Doblas, Juan José (Hospital Universitario Virgen de la Victoria (Màlaga, Andalusia))
González-Juanatey, José R (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Suarez Fernández, Carmen (Instituto de Investigación Hospital Universitario de la Princesa)
Universitat Autònoma de Barcelona

Fecha:	2020
Resumen:	Patients with peripheral artery disease (PAD) are at a high risk not only for the classical cardiovascular (CV) outcomes (major adverse cardiovascular events; MACE) but also for vascular limb events (major adverse limb events; MALE). Therefore, a comprehensive approach for these patients should include both goals. However, the traditional antithrombotic approach with only antiplatelet agents (single or dual antiplatelet therapy) does not sufficiently reduce the risk of recurrent thrombotic events. Importantly, the underlying cause of atherosclerosis in patients with PAD implies both platelet activation and the initiation and promotion of coagulation cascade, in which Factor Xa plays a key role. Therefore, to reduce residual vascular risk, it is necessary to address both targets. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial that included patients with stable atherosclerotic vascular disease, the rivaroxaban plus aspirin strategy (versus aspirin) markedly reduced the risk of both CV and limb outcomes, and related complications, with a good safety profile. In fact, the net clinical benefit outcome composed of MACE; MALE, including major amputation, and fatal or critical organ bleeding was significantly reduced by 28% with the COMPASS strategy, (hazard ratio: 0. 72; 95% confidence interval: 0. 59-0. 87). Therefore, the rivaroxaban plus aspirin approach provides comprehensive protection and should be considered for most patients with PAD at high risk of such events.
Nota:	Altres ajuts: Writing and editorial assistance was funded by Bayer Hispania.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	COMPASS ; Peripheral artery disease ; Residual risk ; Rivaroxaban
Publicado en:	Drugs in Context, Vol. 9 (july 2020) , ISSN 1740-4398

DOI: 10.7573/dic.2020-5-5
PMID: 32699549

15 p, 418.2 KB

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