Key result
Adding low-dose rivaroxaban to aspirin cuts net clinical events ~1% regardless of polypharmacy or multimorbidity.
Why the study?
In patients with coronary or peripheral artery disease, polypharmacy and multimorbidity are common, and whether the benefits and risks of adding low-dose rivaroxaban to aspirin vary across these patient subgroups was unknown.
Does low-dose rivaroxaban plus aspirin reduce ischaemic events compared to aspirin alone in patients with coronary or peripheral artery disease with polypharmacy and multimorbidity?
RCT
Double-blind
Does low-dose rivaroxaban plus aspirin reduce ischaemic events compared to aspirin alone in patients with coronary or peripheral artery disease with polypharmacy and multimorbidity?
Low-dose rivaroxaban added to aspirin is beneficial in CAD/PAD patients regardless of polypharmacy or multimorbidity, yielding greater absolute benefit in those taking more medications.
Answers are grounded in this paper and cite their sources.
Supports rivaroxaban addition in polypharmacy CAD/PAD patients; extends RCT evidence to multimorbid subgroups.
AIMS: To analyse whether the benefits and risks of rivaroxaban plus aspirin vary in patients with comorbidities and receiving multiple drugs. In patients with coronary or peripheral artery disease, adding low-dose rivaroxaban to aspirin reduces cardiovascular events and mortality. Polypharmacy and multimorbidity are frequent in such patients. METHODS AND RESULTS: We describe ischaemic events (cardiovascular death, stroke, or myocardial infarction) and major bleeding in participants from the randomized, double-blind COMPASS study by number of cardiovascular medications and concomitant medical conditions. We compared event rates and hazard ratios (HRs) for rivaroxaban plus aspirin vs. aspirin alone by the number of medications and concomitant conditions, and tested for interaction between polypharmacy or multimorbidity and the antithrombotic regimen. The risk of ischaemic events was higher in patients with more concomitant drugs (HR 1.7, 95% confidence interval 1.5-2.1 for >4 vs. 0-2) and with more comorbidities (HR 2.3, 1.8-2.1 for >3 vs. 0-1). Multimorbidity, but not polypharmacy, was associated with a higher risk of major bleeding. The relative efficacy, safety, and net clinical benefit of rivaroxaban were not affected by the number of drugs or comorbidities. Patients taking more concomitant medications derived the largest absolute reduction in the net clinical outcome with added rivaroxaban (1.1% vs. 0.4% reduction with >4 vs. 0-2 cardiovascular drugs, number needed to treat 91 vs. 250). CONCLUSION: Adding low-dose rivaroxaban to aspirin resulted in benefits irrespective of the number of concomitant drugs or comorbidities. Multiple comorbidities and/or polypharmacy should not dissuade the addition of rivaroxaban to aspirin in otherwise eligible patients.
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Vanassche et al. (2021) conducted an RCT in Coronary or peripheral artery disease. Rivaroxaban plus aspirin vs. Aspirin alone was evaluated on Ischaemic events (cardiovascular death, stroke, or myocardial infarction). Adding low-dose rivaroxaban to aspirin provided consistent benefits regardless of polypharmacy or multimorbidity, yielding a 1.1% absolute reduction in net clinical outcome for those on >4 drugs.
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