Rivaroxaban reduces total ischaemic events after peripheral artery revascularisation

An analysis of the VOAYGER PAD trial results showed that rivaroxaban (2.5 mg twice daily) reduced both first and subsequent adverse limb and cardiovascular events in patients with peripheral artery disease (PAD), and should therefore be considered as adjunctive therapy following lower extremity revascularisation [1,2].

Patients who have PAD are known to have an elevated risk (1 in 5) of major adverse limb and cardiovascular events following lower extremity revascularisation, despite antiplatelet therapy. The previously published VOYAGER PAD (NCT02504216) trial demonstrated that rivaroxaban (a non-vitamin K antagonist oral anticoagulant) combined with usual care lowered the risk of first events [3]. Dr Rupert Bauersachs (Klinikum Darmstadt, Germany) presented results of a pre-specified analysis aimed to assess the impact on both first and subsequent ischaemic events in this population [1].

VOYAGER PAD randomised 6,564 participants with PAD who had recently undergone lower extremity revascularisation to receive either 2.5 mg rivaroxaban twice daily (n=3,286) or a matching placebo (n=3,278) in addition to usual care. The current analysis evaluated all components of the primary endpoint (i.e. myocardial infarction, ischaemic stroke, cardiovascular death, acute limb ischaemia, or major limb amputation due to a vascular cause) as well as additional vascular events (incl. venous thromboembolism and peripheral revascularisations).

A total of 4,714 first and subsequent events occurred among the entire study population in VOYAGER PAD. Of the 1,614 first events, 745 occurred in the rivaroxaban group, and 869 in the placebo group. Rivaroxaban reduced the incidence of first events by 15%. Of the 3,100 remaining subsequent events, 1,659 occurred in the placebo group as compared with only 1,441 in the rivaroxaban group.

1. 
   
   1. Bauersachs RM. Reductions in Total Ischemic Events with Rivaroxaban in Patients with Symptomatic Pad after Revascularization: The VOYAGER PAD Trial. Abstract 406-13, ACC 2021 Scientific Session, 15-17 May.
   2. Bauersachs RM, et al. J. Am. Coll. Cardiol. 2021;16 May.
   3. Bonaca MP, et al. N Engl J Med 2020;382:1994-2004.

 



Posted on 18 May, 202122 July, 2021