Peripheral Artery Disease in Patients With Stable Coronary Artery Disease in General Practice: Prevalence, Management and Clinical Outcomes.

Abstract Aims The COMPASS trial demonstrated that the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily compared with aspirin 100 mg once daily reduced major adverse cardiovascular events (MACE) in patients with chronic coronary artery disease or peripheral artery disease by 24% during a mean follow-up of 23 months. We explored whether this effect varies by sex. Methods and results The effects were examined in women and men using log-rank tests and Kaplan–Meier curve. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were obtained from stratified Cox proportional hazards models to explore subgroup effects including subgroup of women and men according to baseline modified REACH risk score. Of 27 395 patients randomized, 18 278 were allocated to receive rivaroxaban plus aspirin (n = 9152) or aspirin alone (n = 9126), and of these, 22.1% were women. Women compared with men had similar incidence rates for MACE and major bleeding but borderline lower rates for myocardial infarction (1.7% vs. 2.2%, P = 0.05). The effect of combination therapy compared with aspirin in women and men was consistent for MACE (women: 3.8% vs. 5.2%, HR 0.72, 95% CI 0.54–0.97; men: 4.2% vs. 5.5%, HR 0.76, 95% CI 0.66–0.89; P interaction 0.75) and major bleeding (women: 3.1% vs. 1.4%, HR 2.22, 95% CI 1.42–3.46; men: 3.2% vs. 2.0%, HR 1.60, 95% CI 1.29–1.97; P interaction 0.19). There was no significant interaction between randomized treatment and baseline modified REACH score above or below the median for MACE or major bleeding. Conclusion In patients with stable coronary artery disease or peripheral artery disease, the combination of rivaroxaban (2.5 mg twice daily) and aspirin compared with aspirin alone appears to produce consistent benefits in women and men, independent of baseline cardiovascular risk.

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THE IMPACT OF PLATELET-FIBRIN CLOT STRENGTH AND INFLAMMATION ON INCIDENCE OF PERIPHERAL ARTERY DISEASE AND CLINICAL OUTCOMES IN PATIENTS WITH SIGNIFICANT CORONARY ARTERY DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)30652-1 ◽

2018 ◽

Vol 71 (11) ◽

pp. A111

Author(s):

Jae Seok Bae ◽

Jong-Hwa Ahn ◽

Jeong Yoon Jang ◽

Min Gyu Kang ◽

Kyehwan Kim ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Clinical Outcomes ◽

Peripheral Artery Disease ◽

Significant Coronary Artery Disease ◽

Fibrin Clot ◽

Peripheral Artery ◽

Clot Strength ◽

Artery Disease ◽

The Impact

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Pharmacoeconomic study of rivaroxaban and acetylsalicylic acid combination use in patients with coronary artery disease and/or peripheral artery disease

Russian Journal of Cardiology ◽

10.15829/1560-4071-2019-12-76-86 ◽

2019 ◽

pp. 76-86 ◽

Cited By ~ 2

Author(s):

N. V. Pogosova ◽

A. V. Panov ◽

A. Yu. Kulikov ◽

V. G. Serpik ◽

V. A. Kulikov

Keyword(s):

Coronary Artery Disease ◽

Cost Effectiveness ◽

Coronary Artery ◽

Acetylsalicylic Acid ◽

Clinical Outcomes ◽

Peripheral Artery Disease ◽

Impact Analysis ◽

Budget Impact ◽

Peripheral Artery ◽

Artery Disease

Aim. Comparative assessment of the economic results of rivaroxaban/acetylsalicylic acid (ASA) combination and ASA monotherapy use in patients with coronary artery disease (CAD) and/or peripheral artery disease (PAD). Material and methods. Based on the results of a large international multicenter, placebo-controlled, randomized clinical trial COMPASS, a model that evaluated the clinical outcomes of rivaroxaban/ASA combination and ASA monotherapy was formed. The economic results using cost and cost-effectiveness analyses, and budget impact analysis for two years were also calculated. The analysis took into account both direct medical costs (expenses for treatment, hospitalization due to complications, rehabilitation) financed under the compulsory health insurance, as well as indirect costs (loss of GDP due to disability or death). The calculation was made by accounting 100,000 patients with CAD and/or PAD.Results. Modeling of clinical outcomes per 100,000 patients based on COMPASS results showed a decrease of stroke prevalence by 649 cases, myocardial infarction — 301 cases, amputations — 478 cases, cardiovascular mortality — 476 cases when using rivaroxaban/ASA combination compared with ASA monotherapy. The cost-effectiveness analysis showed that rivaroxaban/ASA combination has greater clinical efficacy and lower costs in comparison with ASA monotherapy. Budget impact analysis showed that the switching of 100,000 patients with CAD and/or PAD from ASA monotherapy to rivaroxaban/ASA combination leads to budget savings of 1,026 million rubles in two years. This is due to a decrease in the incidence of cardiovascular events.Conclusion. It was found that the use of a rivaroxaban/ASA combination in comparison with ASA monotherapy in patients with CAD and/or PAD can both decrease a number of complications and lead to cost savings, despite the initially higher cost pharmacotherapy.

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