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