Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Am Heart J. 2020 Apr;222:166-173. doi: 10.1016/j.ahj.2020.01.015. Epub 2020 Jan 28.
Patients with coronary artery disease (CAD), peripheral artery disease (PAD), or both remain at risk of cardiovascular events (including peripheral ischemic events), even when they receive the current guideline-recommended treatment. The phase III COMPASS trial demonstrated that treatment with rivaroxaban vascular dose 2.5 mg twice daily plus aspirin (dual pathway inhibition [DPI] regimen) significantly reduced the risk of major adverse cardiovascular events (including peripheral ischemic events) and increased the risk of major bleeding, but not fatal bleeding or intracranial hemorrhage, versus aspirin alone in patients with CAD, PAD, or both. The results of the COMPASS trial supported the regulatory approval of the DPI regimen in several geographic regions. However, it is unclear whether the patients selected for treatment with the DPI regimen in clinical practice will have a similar risk profile and event rates compared with the COMPASS trial population. The prospective post-approval XATOA registry study aims to assess treatment patterns, as well as ischemic and bleeding outcomes in patients with CAD, PAD, or both, who receive DPI therapy in routine clinical practice. Up to 10,000 patients from at least 400 centers in 22 countries will be enrolled and followed up for a minimum of 12 months, and all treatment will be at the discretion of the prescribing physician. The primary objective of the XATOA study will be to describe early treatment patterns, while ischemic and bleeding outcomes will be described as a secondary objective. TRIAL REGISTRATION NUMBER: NCT03746275.
患有冠状动脉疾病(CAD)、外周动脉疾病(PAD)或两者的患者,即使接受了当前指南推荐的治疗,仍然存在心血管事件(包括外周缺血事件)的风险。III 期 COMPASS 试验表明,与单独使用阿司匹林相比,每日两次服用利伐沙班血管剂量 2.5mg 加阿司匹林(双重途径抑制[DPI]方案)治疗可显著降低主要不良心血管事件(包括外周缺血事件)的风险,并增加大出血的风险,但不增加致命性出血或颅内出血的风险,患有 CAD、PAD 或两者的患者。COMPASS 试验的结果支持了 DPI 方案在几个地理区域的监管批准。然而,尚不清楚在临床实践中选择接受 DPI 方案治疗的患者与 COMPASS 试验人群相比,其风险状况和事件发生率是否相似。前瞻性上市后 XATOA 登记研究旨在评估在常规临床实践中接受 DPI 治疗的 CAD、PAD 或两者患者的治疗模式以及缺血和出血结局。来自 22 个国家至少 400 个中心的多达 10000 名患者将被纳入并随访至少 12 个月,所有治疗将由处方医生决定。XATOA 研究的主要目的将是描述早期的治疗模式,而缺血和出血结局将作为次要目标进行描述。临床试验注册号:NCT03746275。