From the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, location AMC, the Netherlands (M.C.).
McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W., J.W.A.E.).
Circ Res. 2019 Feb;124(3):416-425. doi: 10.1161/CIRCRESAHA.118.313141.
Although acetylsalicylic acid is of proven benefit for secondary prevention in patients with cardiovascular disease, the risk of recurrent ischemic events remains high. Intensification of antithrombotic therapy with more potent antiplatelet drugs, dual antiplatelet therapy, or vitamin K antagonists further reduces the risk of major adverse cardiovascular events compared with acetylsalicylic acid alone but increases the risk of bleeding without reducing mortality. In patients with prior coronary artery disease or peripheral arterial disease the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial revealed that compared with acetylsalicylic acid alone, dual pathway inhibition with low-dose rivaroxaban (2.5 mg twice-daily), an oral factor Xa inhibitor, plus acetylsalicylic acid reduced major adverse cardiovascular event by 24%, major adverse limb events by 47%, and mortality by 18%. Major bleeding was increased by 70%, but there was no increase in fatal or intracranial bleeding. This article (1) reviews the results of the COMPASS trial, (2) explains why dual pathway inhibition is superior to antiplatelet or anticoagulant therapy alone, (3) compares the results with rivaroxaban plus aspirin with those with other antithrombotic regimens, and (4) provides insight into how best to apply the COMPASS results into practice.
虽然乙酰水杨酸已被证明可用于心血管疾病患者的二级预防，但复发缺血事件的风险仍然很高。与单独使用乙酰水杨酸相比，强化抗栓治疗使用更强效的抗血小板药物、双联抗血小板治疗或维生素 K 拮抗剂可进一步降低主要不良心血管事件的风险，但会增加出血风险而不会降低死亡率。在既往患有冠状动脉疾病或外周动脉疾病的患者中，COMPASS（抗凝策略人群的心血管结局）试验表明，与单独使用乙酰水杨酸相比，每日两次低剂量利伐沙班（2.5 毫克）联合使用的双重途径抑制，即口服 Xa 因子抑制剂，加上乙酰水杨酸，可使主要不良心血管事件减少 24%，主要不良肢体事件减少 47%，死亡率降低 18%。大出血风险增加了 70%，但致命性或颅内出血没有增加。本文（1）回顾了 COMPASS 试验的结果，（2）解释了为什么双重途径抑制优于单独的抗血小板或抗凝治疗，（3）比较了利伐沙班加阿司匹林与其他抗栓方案的结果，（4）深入了解如何将 COMPASS 结果最佳地应用于实践。
