After CABG, rivaroxaban plus aspirin fails to reduce graft failure: COMPASS substudy

  • J Am Coll Cardiol

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For recipients of coronary artery bypass graft (CABG), therapy with rivaroxaban (Xarelto; Janssen Pharmaceuticals) plus aspirin does not reduce graft failure compared with either drug alone.

Why this matters

  • This population is at high risk for early graft failure. 

Key results

  • 3562 grafts evaluated; 296 (8.3%) were occluded.
  • Primary outcome, rivaroxaban vs combination therapy vs aspirin: 7.8% vs 9.1% vs 8.0%.
  • No significant differences in:
    • ORs for primary outcome;
    • ORs for patient-level graft occlusion;
    • HRs for major adverse cardiovascular events (MACE) (composite of cardiovascular death, myocardial infarction, stroke), though there were numerically fewer episodes with combination therapy; 
    • HRs for major bleeding in first 30 days.
  • For rivaroxaban vs aspirin, major bleeding after 30 days: HR, 2.43 (95% CI, 1.06-5.54; P=.03).

Study design

  • Planned substudy of COMPASS.
    • Trial compared treatment with rivaroxaban alone, rivaroxaban plus aspirin, and aspirin alone;
    • Combination therapy reduced MACE; trial stopped early.
  • This study examined these treatments in 1448 patients who underwent CABG in ≥2 vessels.
  • Participants began treatment within 4-14 days of surgery.
  • Outcome: graft failure on CT angiography (CTA) at 1 year.
  • Funding: Bayer.

Limitations

  • May be underpowered.
  • 22% of patients did not undergo 1-year CTA, further reducing power.
  • Highest-risk patients comprised low proportion of participants.

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