Rivaroxaban With or Without Aspirin for the Secondary Prevention of Cardiovascular Disease

Clinical Implications of the COMPASS Trial

Stephen J. Nicholls; Adam J. Nelson


Am J Cardiovasc Drugs. 2019;19(4):343-348. 

In This Article


The COMPASS trial has provided renewed enthusiasm for antithrombotic therapies in patients with stable atherosclerotic vascular disease. A very low dose of rivaroxaban appears to derive net clinical benefit by improving ischemic endpoints without intolerable, excess bleeding. Put in the context of the ATLAS trial, this now represents a continuum of patients with both acute and chronic vascular disease who are likely to derive benefit from the addition of a low dose of antithrombotic medication. With a growing pharmacopeia of drugs aimed at reducing cardiovascular events, from potent anti-inflammatories to parenteral lipid-lowering agents, the evolving clinical (and health economical) challenge is to understand which patient is likely to benefit most from each additional agent. Real-world evidence and precision medicine may have the answers.