Total Ischemic Event Reduction With Rivaroxaban After Peripheral Arterial Revascularization in the VOYAGER PAD Trial

<p>Background: Patients with peripheral artery disease (PAD) undergoing Lower extremity revascularization (LER) are at high risk of major adverse limb and cardiovascular events.</p> <p>The VOYAGER PAD trial demonstrated that rivaroxaban 2.5 mg twice daily reduced first events by 15%. The benefit of rivaroxaban on total (first and subsequent) events in this population are unknown.</p> <p>The Objectives: of this study sought to evaluate the total burden of vascular events in patients with PAD after Lower extremity revascularization and the efficacy of low-dose rivaroxaban on total events.</p> <p>Methods: &nbsp;In this study patients with PAD undergoing Lower extremity revascularization were randomized to rivaroxaban 2.5 mg twice daily plus aspirin or aspirin alone.</p> <p>The primary endpoint was time to the first event of acute limb ischemia, major amputation of a vascular cause, myocardial infarction, ischemic stroke, or cardiovascular death.</p> <p>The current analysis considered all events (first and subsequent) for components of the primary endpoint as well as additional vascular events including peripheral revascularizations and venous thromboembolism.</p> <p>As Results: Rivaroxaban significantly reduced total primary endpoint events and total vascular events by (<strong>HR: 0.86</strong>; 95% CI: 0.75-0.98; P = 0.02) &amp; (HR: 0.86; 95% CI: 0.79-0.95; P = 0.003) respectively.</p> <p>An estimated 4.4 primary and 12.5 vascular events per 100 participants were avoided with rivaroxaban over 3 years.</p> <p>Conclusions: Patients with <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/arteriosclerosis-obliterans" title="Learn more about PAD from ScienceDirect's AI-generated Topic Pages">PAD</a> undergoing Lower extremity revascularization are at high risk of adverse limb and cardiovascular events, with a particularly high burden when considering total events in spite of standard available medical therapy.</p> <p>The risk profile in patients with symptomatic PAD is dominantly driven by adverse li