COMPASS-CABG: Rivaroxaban Not Linked with Preventing Outcomes After CABG

Low-dose rivaroxaban for the prevention of outcomes from coronary artery bypass graft (CABG) provided no additional benefit, according to new research.

The researchers, publishing in the Journal of the American College of Cardiology, conducted the COMPASS-CABG as a substudy of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial looking specifically graft failure in patients who underwent CABG taking either rivaroxaban or aspirin. Participants in COMPASS-CABG (n=1,448) were enrolled four to 14 days after CABG surgery to either rivaroxaban plus aspirin, rivaroxaban alone, or aspirin alone. The primary study outcome was graft failure at a year post-surgery.

New research in #JACC examines combination rivaroxaban + aspirin for #cvCABG outcomes. Will this change your practice? https://t.co/yVtbFFyr7n @McMasterU pic.twitter.com/QhpPRIMGn8

— JACC Journals (@JACCJournals) January 16, 2019

According to the results, the combination of aspirin plus rivaroxaban (P=0.45 for comparison), and rivaroxaban alone (P=0.75), were not associated with a reduction in graft failure rates compared to aspirin alone. Combination therapy was associated with a small trend toward reduction in major adverse cardiac events (P=0.34) when compared to aspirin alone, whereas rivaroxaban alone was not (P=0.98).

“The combination of rivaroxaban 2.5 mg twice daily plus aspirin or rivaroxaban 5 mg twice daily alone compared with aspirin alone did not reduce graft failure in patients with recent CABG surgery, but the combination of rivaroxaban 2.5 mg twice daily plus aspirin was associated with similar reductions in MACE, as observed in the larger COMPASS trial,” the researchers wrote in their conclusion.

Rivaroxaban, Aspirin, or Both to Prevent Early Coronary Bypass Graft Occlusion https://t.co/lztUu2hLil

— Dr. Deepak L. Bhatt (@DLBHATTMD) January 15, 2019

https://twitter.com/ATRIUMRx/statuses/1085297719512576001

The combination of rivaroxaban 2.5 mg twice daily plus aspirin after CABG was associated with similar reductions in MACE as observed in the COMPASS trial https://t.co/kJ0sLPZbn3

— Alberto Cordero (@acorderofort) January 14, 2019

Proceed with caution! This study in @JACCJournals reports less MACE when #rivaroxaban added to #aspirin post #CABG. The abstract doesn't mention that major bleeding was up! https://t.co/eSDfG9Zh83 pic.twitter.com/2zEexKzwCy

— Cia Connell (@CiaConnell) January 14, 2019

COMPASS-CABG Study
1️⃣ Rivaroxaban 2.5 mg twice daily plus aspirin vs aspirin alone did not ⬇️ graft failure in patients with recent CABG surgery,
BUT
2️⃣ ⬇️ MACE, as observed in the larger COMPASS trial.@JACCJournals @secardiologia @SACardiologia https://t.co/5QV41I9KEh pic.twitter.com/8PXAygNAqy

— Javier Torres (@JTLLERGO) January 14, 2019

Source: Journal of the American College of Cardiology