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COMPASS for Vascular Surgeons

Practical Considerations

Hussain, Mohamad A.a,b; Wheatcroft, Marka,b; Nault, Patricec; Lindsay, Thomas F.a,d; Bhatt, Deepak L.e; Anand, Sonia S.f; Verma, Subodha,g; Al-Omran, Mohammeda,b,h

Current Opinion in Cardiology: March 2019 - Volume 34 - Issue 2 - p 178–184
doi: 10.1097/HCO.0000000000000597
VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa

Purpose of review To suggest a practical approach for the application of data from the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial in patients with peripheral artery disease (PAD).

Recent findings The COMPASS trial showed that low-dose rivaroxaban 2.5 mg twice daily plus daily aspirin was superior to aspirin alone in reducing major adverse cardiovascular and cerebrovascular events, and major adverse limb events among patients with stable atherosclerotic vascular disease, including those with PAD. The risk for major bleeding, however, was higher with rivaroxaban plus aspirin. Critical limb ischemia at baseline (rest pain, ulcer, or gangrene), previous limb or foot amputation, or a history of peripheral revascularization surgery or stenting were independently associated with increased major adverse limb events within the trial.

Summary Intensification of antithrombotic therapy with low-dose rivaroxaban plus aspirin should be considered in low bleeding risk PAD patients who are at increased risk for ischemic and/or limb events. A practical approach for clinicians is presented to help incorporate COMPASS data into practice.

aDepartment of Surgery, University of Toronto

bDivision of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario

cMcGill University, Montreal, and Division of Vascular and Endovascular Surgery, Centre Intégré de la santé et des services sociaux de l’Outaouais, Gatineau

dDivision of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

eBrigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA

fPopulation Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton

gDivision of Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada

hDepartment of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia

Correspondence to Mohammed Al-Omran, MD, MSc, Professor and Head, Division of Vascular Surgery, St. Michael's Hospital, 30 Bond Street, Suite 7-074, Toronto, ON M5B1W8, Canada. Tel: +416 864 6047; fax: +416 864 6012; e-mail:

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