New possibilities of antithrombotic therapy improving prognosis in patients with stenosing atherosclerosis of carotid arteries

Abstract

The purpose of the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial was to evaluate a regimen of a two-way impact on thrombus formation in patients presenting with ischaemic heart disease and peripheral artery diseases. The study included a total of 1,919 patients with stenosis of carotid arteries and 1,032 patients with a history of stroke. Many patients with disease of peripheral arteries (including carotid arteries) enrolled into the COMPASS trial appeared to have additional risk factors for stroke such as, for instance, current or former smoking, diabetes mellitus, or ischaemic heart disease. An additionally carried out analysis for strokes revealed that supplementing rivaroxaban at a dose of 2.5 mg twice daily to acetylsalicylic acid decreased the risk for the development of ischaemic stroke by 49% (p<0.001), without increasing the risk for haemorrhagic transformation on the background of combined therapy (HR=0.35; 95% CI: 0.13-0.99; p=0.04), whereas the risk for haemorrhagic strokes remained at a low level and did not differ between the groups (HR=1.49; 95% CI: 0.67-3.31; p=0.33). The composite risk for major ischaemic and haemorrhagic events was significantly lower in the group of combined therapy. Adding rivaroxaban to acetylsalicylic acid appeared to result in a decrease in the risk of all-cause mortality in patients with ischaemic heart disease and peripheral artery disease by 18%. Thus, the addition of rivaroxaban at a dose of 2.5 mg twice daily to acetylsalicylic acid made it possible to decrease the risks of both primary and secondary strokes, and hence may be considered in patients with significant stenoses of carotid arteries for primary prevention, whereas in patients with endured ischaemic stroke - for secondary prevention, as well as after open endovascular reconstructive operations on carotid arteries.