Rivaroxaban in Diabetic Patients with Critical Limb Ischemia

On this month’s Heart Trials, HCPLive’s newest specialty podcast series, Marc Bonaca, MD, MPH, of CPC Clinical Research, spoke on a new analysis of the VOYAGER PAD trial, introduced by Manesh Patel, MD, last episode.

Presented at the American Diabetes Association (ADA) 2021 Scientific Sessions, the analysis assessed the efficacy and safety of 2.5 mg twice-daily rivaroxaban plus aspirin in patients with critical limb ischemia (CLI) with and without diabetes.

The investigators found that the regimen was associated with a 5.5% reduction in absolute composite endpoint risk—consisting of risk for acute limb ischemia, vascular-related major amputation, myocardial infarction, ischemic stroke, or cardiovascular-related death—in diabetic plus CLI patients.

The efficacy and safety of rivaroxaban were notably consistent with that of the overall trial population, showing that the antithrombotic agent can provide consistent benefit to a particularly high-risk diabetic population.

Reflecting on these findings and what they could mean for cardiac and vascular care, Bonaca stressed that the potential of peripheral artery disease (PAD) and/or CLI should not be overlooked for patients with history of diabetes-associated complications.

“I think this is a wake-up call,” he said.

“When you have a diabetes patient, particularly if they’ve had disease for a while and they’re starting to manifest other disease complications like neuropathy, you have to think about PAD,” he continued. “If you’re asking why does it matter, well now we know there’s a therapy you can add that will change the course of their disease.”

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