Clot Chronicles: What Clinicians Should Know About the COMPASS Trial

NATF is proud to introduce the new Clot Chronicles with Dr. Sam Goldhaber. Tune-in to learn about the latest novel thrombosis research.

This is Dr. Sam Goldhaber. I’m the President of NATF and this is my inaugural Clot Chronicle for NATF. Today, we’re going to talk about the important new study called COMPASS.

This is a trial that was done to test the best pharmacological ways to prevent heart attack, and stroke, and cardiovascular death in patients who have either established coronary artery disease or established peripheral arterial disease. Both of these diseases are clot-based diseases, and the COMPASS trial tested a combination of low dose anticoagulation plus or minus aspirin against low dose aspirin alone to see which strategy would have the greatest beneficial effect. And in fact, this trial, which randomized nearly thirty thousand patients, was stopped early because of the dramatic effect in favor of tiny doses of the anticoagulant Rivaroxaban, only 2.5 milligrams twice a day in combination with low dose aspirin. That compared with low dose aspirin alone reduced cardiovascular death, reduced stroke, reduced heart attack rates, and even reduced new cases of pulmonary embolism and DVT.

Well, what can we learn from the COMPASS trial? Apparently, it’s important to treat not only fibrin thrombus, the so called ‘red clot’, but also at the same time to inactivate platelets with low doses of aspirin, and by giving a very low dose of an anticoagulant the risk of major bleeding complications can be minimized. It’s likely that this combination therapy is going to become wide spread throughout the world in patients who have cardiovascular disease.

As for the peripheral arterial disease component of the COMPASS trial, peripheral arterial disease included patients who had blockages in their carotid artery that could be only fifty or sixty percent blocked. Even they had a reduction in heart attack and stroke. For patients who had peripheral arterial obstructive disease of the leg, this medical therapy reduced the frequency of leg amputation as well.

So, in summary the COMPASS trial is a breakthrough pivotal landmark trial that is going to revolutionize our choices for medical therapy with patients with coronary artery disease and pulmonary arterial disease.

This is Dr. Sam Goldhaber for Clot Chronicles.


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