ACC House Call: COMPASS Diabetes Insights with Deepak Bhatt, MD

While the results of COMPASS solidified the role of rivaroxaban (Xarelto) 2.5 mg plus aspirin for treatment of coronary artery disease (CAD) and peripheral artery disease (PAD), many cardiologists and clinicians were left with questions over the real-world applicability of results.

Thanks to a prespecified subgroup analysis presented at the ACC’s Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC), clinicians now have more information on how the impact of rivaroxaban might differ between diabetics and nondiabetics with CAD or PAD.

Results of COMPASS, which included 27,395 patients, indicated use of rivaroxaban 2.5 mg plus aspirin twice daily reduced the risk of a composite of cardiovascular death, stroke, or myocardial infarction better than aspirin-alone (HR, 0.76; 95% CI, 0.66-0.86; P <.001). While there was an apparent risk in major bleeding, investigators pointed out there was no significant difference in intracranial or fatal bleeding between the 2 groups (HR, 1.70; 95% CI, 1.40-2.05; P <.001).

The newest COMPASS subgroup analysis—presented by Deepak Bhatt, MD, executive director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital&mdash;examined the impact in the 10,341 patients with and 17,054 without diabetes at baseline. Results of the analysis indicated a similar relative risk reduction for rivaroxaban plus aspirin compared to aspirin alone for the composite endpoint (HR 0.74, P=0.002 and HR 0.77, P=0.005, respectively, P for interaction=.77) and all-cause mortality (HR 0.81, P=0.05 and HR 0.84, P=0.09, respectively, P for interaction=.82).

Results also indicated absolute risk reductions were greater for patients with diabetes than those without for the primary efficacy endpoint (2.3% vs. 1.4%, P for interaction <.0001), all-cause mortality (1.8% vs. 0.6%, P for interaction=.02), and major vascular events (2.7% vs. 1.7%, P for interaction <.0001) at 3 years—the risk of bleeding hazards were similar between those with and without diabetes.

For greater insight into the results and how the data can be applied to clinical practice, HCPLive® reached out to Bhatt to discuss the analysis in a special edition ACC House Call.

This study, “The Role Of Combination Antiplatelet And Anticoagulation Therapy In Diabetes And Cardiovascular Disease: Insights From The Compass Trial,” was presented at ACC.20/WCC.