Identifying higher risk patients among the COMPASS-Eligible population: An analysis from the REduction of Atherothrombosis for Continued Health (REACH) Registry - 25/12/18
, E. Sorbets 1, 3, G. Ducrocq 1, 2, Y. Elbez 1, J. Abtan 1, 2, B. Popovic 4, E.M. Ohman 5, J. Roether 6, P.W.F. Wilson 7, G. Montalescot 8, U. Zeymer 9, D.L. Bhatt 10, P.G. Steg 1, 2Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Résumé |
Background |
The COMPASS trial showed that a combination of rivaroxaban and aspirin improved outcomes in patients with stable vascular disease compared with aspirin alone, but at the cost of an overall increase in bleeding.
Purpose |
Describe the baseline characteristics and outcomes of relevant subgroups within the COMPASS-eligible population (CEP) in the REACH Registry and identify subgroups with higher ischemic and lower bleeding risk profile.
Methods |
Within the CEP, (fulfilling COMPASS inclusion and exclusion criteria) we identified the following subgroups: diabetes, MI<1 year, age>65 years, asymptomatic carotid stenosis>70%, heart failure (HF), and stage III chronic kidney disease (CKD). We describe the composite outcome of MI, stroke or CV death, expressed as rates per 100 patient-years and serious bleeding rate at 1 year (bleeding requiring transfusion, hospitalization or hemorrhagic stroke)
Results |
From the overall CEP (n=16.875), 81.5% were aged>65 years, 41.0% had diabetes, 40.2% had stage III CKD, 13.3% had HF, 8.7% had asymptomatic carotid stenosis and 5.9% had a history of MI<1 year. Patients with HF, MI<1 year, and stage III CKD had the higher incidence rates of the primary outcome, compared with the overall CEP (7.5, 5.6, and 5.3 vs. 4.2 respectively) (Fig. 1). Patients with a history of MI<1 year, stage III CKD or diabetes had a higher incidence of CV Death/MI/Stroke compared with those who did not (5.6 vs. 3.6, 5.3 vs. 3.4, and 5.0 vs. 3.4, respectively, P<0.05). Patients with history of MI<1 year, stage III CKD or diabetes had similar rates of serious bleeding than the overall CEP at 1 year (Table 1).
Conclusions |
Within the COMPASS-eligible patients, those with a history of MI<1 year, stage III CKD or diabetes, experience a higher risk of ischemic events, with no excess in serious bleedings and appear potentially attractive candidates to more potent treatment such as addition of low dose rivaroxaban to single antiplatelet therapy.
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Vol 11 - N° 1
P. 6-7 - janvier 2019 Retour au numéro
Article précédent
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