O070 Can the compass trial recommendations be implemented following symptomatic carotid endarterectomy (CEA)?

Abstract

Abstract Introduction The paradigm changing COMPASS trial (1) demonstrated that in stable atherosclerotic disease, low-dose Rivaroxaban and Aspirin has a significantly greater protective effect on subsequent cardiovascular events (death, stroke or myocardial infarct) than antiplatelet medication alone. This included carotid endarterectomy patients. We assessed our success at implementing COMPASS in our symptomatic CEA patients Methods At the four-week virtual post-CEA review, in suitable patients the general practitioner was advised to change from single antiplatelet to COMPASS regimen. At 6-month follow-up the success and safety of the conversion was assessed. Results For 18 months up to February 2021, 47 patients underwent successful CEA. 29 were recommended for COMPASS, 3 were lost to follow up and 15 were not suitable (6 on DOAC for AF/VTE, 9 complex drug regimen). At 6 months 18 of 29 patients were on the COMPASS regimen (9 not started; 2 withdrawn due to bruising). All patients reported compliance to the regimen. There were no reported haemorrhagic events. 1 patient (not in the COMPASS group) had further multi-territory cerebrovascular events. Conclusion COMPASS is well tolerated in this cohort. Conversion from established drug regimens has yet to gain traction. The benefits on future cardiovascular events post-CEA is yet to be determined. Take-home message Changing post-op medications after a carotid endarterectomy can reduce the later risk of Cardiovascular events. We demonstrate it is possible to successfully do this, but should aim for a higher rate of uptake. (1): N Engl J Med 2017; 377:1319–1330 DOI: 10.1056/NEJMoa1709118