A previous analysis of the REACH Registry showed that 52.9% of stable vascular patients were eligible to COMPASS. However, data regarding eligibility to COMPASS in CAD patients from real life practice are scarce.

To describe the proportion, management and outcomes of patients eligible to COMPASS and to compare patients excluded, eligible, and who did not meet the “enrichment criteria” (COMPASS Excluded, Eligible and Not Included).

We used the CLARIFY Registry (>30.000 stable CAD patients). According to COMPASS protocol, patients with a REACH bleeding risk score (BRS)>10, heart failure, severe renal failure, need for dual antiplatelet therapy (DAPT), or anticoagulant therapy were excluded. Then, COMPASS inclusion criteria were applied: CAD patients had to be>65 years, if younger, have documented atherosclerosis, or at least two enrichment criteria (current smoker, diabetes, GFR<60mL/min, or non lacunar ischemic stroke). Ischemic outcome: CV death, MI, or stroke. Bleeding outcome: bleeding leading to admission, transfusion, or haemorrhagic stroke.

A total of 15.185 patients had comprehensive data allowing precise assessment of eligibility, from which 43.1% had at least one exclusion criteria, 23.1% did not have enrichment criteria and 33.9% were eligible. The vast majority were excluded due to high bleeding risk (62.7% needing DAPT, and 52.7% for high REACH BRS). Ischemic and bleeding outcome (100 patients/year) were 2.3 [2.1–2.5] and 0.5 [0.4–0.6] respectively for COMPASS-Eligible, 3.0 [2.8–3.2] and 0.6 [0.5–0.7] for COMPASS-Excluded and 1.2 [1.0–1.4] and 0.2 [0.2–0.3] for COMPASS-Not Included.

In a large registry of stable CAD patients, approximately one of three patients was potentially eligible for adjunction of low-dose rivaroxaban to aspirin, and remains at high risk of ischemic outcome. COMPASS-Excluded had the worse ischemic and bleeding outcomes and represent a group in need of improved therapy.