Effects of rivaroxaban plus aspirin consistent regardless of BMI, weight: COMPASS
The effects found with low-dose rivaroxaban plus aspirin are consistent regardless of patient BMI and weight, according to research published in the Journal of the American College of Cardiology.
“We have a number of highly effective medications available in prevention of cardiovascular disease in patients with severe atherosclerosis,” Tomasz J. Guzik, MD, PhD, professor of physiology and cardiovascular medicine at the Institute of Cardiovascular & Medical Sciences at the British Heart Foundation Glasgow Cardiovascular Research Centre and honorary consultant physician at Queen Elizabeth University Hospital, Glasgow, U.K., told Healio. “While these help large numbers of people, some of our patients, in spite of intensive treatments, still develop heart attacks and strokes.”
The COMPASS trial included 27,395 patients with chronic CAD or peripheral artery disease. This secondary analysis aimed to evaluate the efficacy and safety outcomes of the dual-pathway inhibition antithrombotic regimen of rivaroxaban (Xarelto, Janssen/Bayer; 2.5 mg, twice daily) plus aspirin (100 mg per day) in relation to patient BMI and weight.
In the cohort, 24% had normal BMI (18.5-25 kg/m2), 44% were overweight (BMI 25-30 kg/m2) and 32% were obese (BMI > 30 kg/m2).
Compared with aspirin alone, dual-pathway antithrombotic therapy resulted in an HR of 0.73 (95% credible interval [CrI], 0.58-0.9) for those with normal-weight BMI, 0.8 (95% CI, 0.66-0.96) for those with overweight BMI and 0.71 (95% CI, 0.57-0.86) for those with obese BMI for the primary outcome of CV death/stroke/MI (P for interaction = .565).
For patient body weight, dual-pathway antithrombotic therapy resulted in an HR of 0.75 (95% CI, 0.62-0.91) for those weighing less than 70 kg, 0.76 (95% CI, 0.65-0.89) for those weighing 70 kg to 90 kg and 0.74 (95% CI, 0.61-0.9) for those weighing more than 90 kg for the primary outcome compared with aspirin alone.
Dual-pathway antithrombotic therapy also demonstrated consistent effects on bleeding, mortality and clinical benefit regardless of patient BMI or weight, according to the researchers.
“This study is an important step forward, but we do need further studies to confirm these results in subjects with very high or very low weights, as these patients were not sufficiently represented in the COMPASS trial population,” Guzik said.
Further data needed
In a related editorial, Karlyn Martin, MD, MS, assistant professor of medicine (hematology/oncology), and Sadiya S. Khan, MD, MSc, assistant professor of medicine (cardiology) and preventive medicine (epidemiology), both at Northwestern University Feinberg School of Medicine, noted that the findings of this subanalysis add critical data to research supporting broader use of direct oral anticoagulant therapy across different BMI.
“Further data are needed to contextualize the role of dual antithrombotic regimens more broadly, as well as in targeted subpopulations at high residual risk for recurrent [atherosclerotic] CVD events,” Martin and Khan wrote.
For more information:
Tomasz J. Guzik, MD, PhD, can be reached at Tomasz.Guzik@glasgow.ac.uk.