Debus on DOAC after revasc.

Prof Debus, ex ESVS president, summarises role of DOAC therapy post revascularisation

Debus states that neither the use of single or dual antiplatelets, nor full anticoagulation, was found on clinical research to substantially improve limb or mortality outcomes post revascularisation

COMPASS trial was stopped early because the benefit seen in preventing MACE was substantial (26%). The truncation stimulated set up of the VOYAGER PAD trial.

Full data set on VOYAGER PAD - 2.6% absolute risk reduction over 3 years of composite primary endpoint of ALI, Major LL amputation of vascular aetiology, MI, Ischaemic stroke or Cardiovascular death. NNT=39.

The arm that had the benefit of 2.6% was given Aspirin 75 + Rivaroxaban 2.5 BD daily. The other arm had Aspirin and Placebo.

The benefit in the surgical subgroup analysis of VOYAGER PAD was even more pronounced.

4.2% absolute risk reduction over 3 years of composite primary endpoint of ALI, Major LL amputation of vascular aetiology, MI, Ischaemic stroke or Cardiovascular death. NNT=24.

The surgical revascularisation sub-group had only open surgery, not endovascular recanalisation.

The Aspirin + low dose Riva benefit was maintained across both conduit types, although vein fared better.