Anti-thrombotic options for secondary prevention in patients with chronic atherosclerotic vascular disease: what does COMPASS add?

Fox, Keith A.A.; Eikelboom, John W.; Anand, Sonia S.; Bhatt, Deepak L.; Bosch, Jackie; Connolly, Stuart J.; Harrington, Robert A.; Steg, Ph. Gabriel; Yusuf, Salim

doi:10.1093/eurheartj/ehy347

Cited by 24 publications

(16 citation statements)

References 47 publications

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“…9 The COMPASS trial demonstrated that the addition of low-dose rivaroxaban to aspirin reduces ischemic events with an overall benefit but at the expense of up to 70% increased bleeding risk. 9,10 The increased bleeding during rivaroxaban treatment calls for a more targeted approach by identifying higher risk groups that can be subjected to a combination of antiplatelet and anticoagulant therapies.…”

Section: Introductionmentioning

confidence: 99%

Imbalance between Fibrin Clot Formation and Fibrinolysis Predicts Cardiovascular Events in Patients with Stable Coronary Artery Disease

et al. 2019

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Background Despite long-term antiplatelet therapy with aspirin, recurrent cardiovascular events remain common in patients with coronary artery disease (CAD). Objective We aimed to determine whether fibrin network characteristics are predictive of vascular events in patients with stable CAD treated with aspirin monotherapy. Methods We included 786 patients with angiographically documented CAD and either prior myocardial infarction, type 2 diabetes mellitus, or both. Median follow-up time was 3 years. At inclusion, fibrin clot properties were evaluated using a turbidimetric assay and the following clot parameters were studied: (1) maximum absorbance, a measure of clot density and fiber thickness; (2) lysis time, assessing fibrinolysis potential; and (3) area under the curve (AUC), a measure of clot formation and lysis. The primary endpoint was the composite of nonfatal myocardial infarction, ischemic stroke, and cardiovascular death. Hazard ratios (HRs) were estimated using multivariable Cox proportional hazards regression. Results A total of 70 primary endpoints occurred. The primary endpoint occurred more frequently in CAD patients with increased clot AUC (crude HR for first vs. fourth quartile: 2.4 [95% confidence interval 1.2–4.6], p = 0.01). This finding remained significant after adjusting for potential confounders (adjusted HR: 2.4 [1.2–4.8], p = 0.01). Neither clot maximum absorbance nor lysis time showed significant association with future vascular events (adjusted HR for maximum absorbance 1.8 [0.9–3.7]; p = 0.09) and lysis time (1.6 [0.8–3.0]; p = 0.18). Conclusion We demonstrate that increased clot AUC predicts future cardiovascular events in stable CAD patients receiving aspirin monotherapy.

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Section: Introductionmentioning

confidence: 99%

Imbalance between Fibrin Clot Formation and Fibrinolysis Predicts Cardiovascular Events in Patients with Stable Coronary Artery Disease

et al. 2019

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“…The impact of different regimens in the context of proven secondary prevention regimens (ASA, lipid lowering, blood pressure, and ACE inhibitors)2,3,43,61,85,114 .…”

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confidence: 99%

The myth of ‘stable’ coronary artery disease

et al. 2019

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Patients with known cardiovascular (CV) disease who have not suffered a recent acute event are often referred to as having 'stable coronary artery disease (CAD)'. The concept of 'stable' CAD is misleading for two key reasons: the continuing risks of CV events over the longer term, and the diverse but powerful spectrum of risk characteristics. The risks of CV events are frequently underestimated and occur despite current standards of care for secondary prevention, including lifestyle changes, optimal medical therapy, myocardial revascularization, and use of antiplatelet agents to limit thrombosis. In dispelling the myth of 'stable' CAD, we explore the pathophysiology of the disease and the relative contribution of plaque and systemic factors to CV events. A broader concept of the vulnerable patient, not just the 'vulnerable' plaque, takes into account the diversity and future risks of atherothrombotic events. We also evaluate new and ongoing research into medical therapies aimed at further reducing the risks of CV events in patients with chronic but not 'stable' atherothrombotic disease.

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“…2,3 The authors present a series of 197 patients who received 161 aortic and 49 mitral Cingular (Shanghai Cingular Biotech Corporation, Shanghai, China) valve replacements. 4 Their primary outcome was a composite of thromboembolism, valve thrombosis, major bleeding, major paravalvular leak, and prosthetic valve endocarditis, in accordance with the objective performance criteria established by the Society of Thoracic Surgeons (STS) for introduction of new prosthetic valves into the market. 5 Transthoracic echocardiography at 1 and 12 months assessed EOA and incidence of patient-prosthesis mismatch.…”

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confidence: 99%