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COMPASS: Low-dose rivaroxaban plus aspirin confers reduced embolic stroke risk
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According to new data from the COMPASS trial, patients with systemic atherosclerosis assigned low-dose rivaroxaban plus aspirin had reduced risk for cardioembolic stroke and embolic stroke of undetermined origin compared with patients assigned aspirin alone.
As Healio previously reported, in the main results of COMPASS, in patients with stable atherosclerotic vascular disease, those assigned rivaroxaban (Xarelto, Janssen/Bayer) 2.5 mg twice daily plus aspirin 100 mg once daily had lower rates of stroke/CV death/MI but higher rates of bleeding at 23 months compared with those assigned aspirin 100 mg once daily.
For the present analysis, the researchers analyzed the risk for ischemic stroke subtypes.
During the study period, 291 patients experienced an ischemic stroke (66 women; mean age, 69.4 years), of which 20.3% were cardioembolic, 18.6% were secondary to 50% or more stenosis of the ipsilateral internal carotid artery, 14.4% were embolic stroke of undetermined source and 7.2% were secondary to small vessel disease, Kanjana S. Perera, MBBS, assistant professor of neurology at McMaster University in Hamilton, Ontario, Canada, and investigator in the Stroke and Cognition Program at the Population Health Research Institute and Hamilton Health Sciences, and colleagues wrote.
The rivaroxaban-aspirin group had lower risk for cardioembolic stroke (HR = 0.4; 95% CI, 0.2-0.78) and embolic stroke of undetermined source (HR = 0.3; 95% CI, 0.12-0.74) compared with the aspirin-alone group, according to the researchers.
There was no difference between the groups in risk for stroke secondary to 50% or more stenosis of the ipsilateral internal carotid artery (HR = 0.85; 95% CI, 0.45-1.6) and a trend toward favoring the rivaroxaban-aspirin group in risk for stroke secondary to small vessel disease (HR = 0.36; 95% CI, 0.12-1.14), Perera and colleagues wrote.
Patients assigned rivaroxaban 5 mg twice daily with no aspirin had a trend toward less risk for cardioembolic stroke compared with the aspirin-alone group (HR = 0.57; 95% CI, 0.31-1.03) but did not differ from the aspirin-alone group in risk for the other ischemic stroke subtypes, according to the researchers.
“Low-dose rivaroxaban plus aspirin was associated with a reduced risk of all ischemic strokes and with large, significant reductions in cardioembolic strokes and embolic stroke of undetermined source among patients with systemic atherosclerotic disease; however, these observations need to be independently confirmed before influencing clinical practice,” the researchers wrote. “In the wake of two recent trials with neutral results assessing anticoagulant treatment for secondary stroke prevention in patients with embolic stroke of undetermined source, these findings make a compelling case for testing this combination in patients with embolic stroke of undetermined source, as well as in those with cardioembolic strokes.” – by Erik Swain
Disclosures: The study was funded by Bayer. Perera reports she received grants from Bayer. Please see the study for the other authors’ relevant financial disclosures.
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