Mortality benefit with different antithrombotic therapies in patients with stable vascular disease: from pathophysiology to the clinical impact in the real world. The COMPASS study

The evaluation and application of antithrombotic strategies able to reduce total and cardiovascular mortality in patients with documented vascular disease have an important clinical and epidemiological role and may also impact on health costs. In the COMPASS trial, the association of rivaroxaban at the dose of 2.5 mg twice daily with aspirin in a population with stable vascular disease has significantly reduced the incidence of cardiovascular events compared to the standard regimen of aspirin alone; this reduction translated into greater cardiovascular and total survival. Such mortality benefit was not observed in previous randomized trials that in this setting of patients had previously evaluated antiplatelet strategies alternative to aspirin (with clopidogrel) or had compared a dual antiplatelet therapy with aspirin plus clopidogrel, vorapaxar, or ticagrelor vs a single antiplatelet treatment with aspirin. The results of the COMPASS trial strengthen the role of antithrombotic strategies that, beside the platelet phase, also involve the coagulative phase with the aim at preventing the recurrence of cardiovascular, atherothrombotic events at the site of polyvascular beds, with a degree of benefit proportional to the baseline risk of the patient.