Dual pathway inhibition in patients with peripheral artery disease in Germany

Joerg Herold; Nikolaos Dagkonakis; E Sebastian Debus; Ursula Rauch-Kröhnert; Uwe Zeymer; Rupert M Bauersachs

doi:10.1024/0301-1526/a001174

Dual pathway inhibition in patients with peripheral artery disease in Germany

Vasa. 2025 Jan 10. doi: 10.1024/0301-1526/a001174. Online ahead of print.

Authors

Joerg Herold¹, Nikolaos Dagkonakis², E Sebastian Debus³, Ursula Rauch-Kröhnert⁴, Uwe Zeymer⁵, Rupert M Bauersachs^{6

7}

Affiliations

¹ Department of Angiology, Kerckhoff Clinic, Bad Nauheim, Germany.
² Medizinische Klinik II, Klinikum Konstanz, Germany.
³ Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Germany.
⁴ Klinik für Kardiologie, Angiologie und Intensivmedizin CBF, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin, Germany.
⁵ Medizinische Klinik B, Klinikum Ludwigshafen, Germany.
⁶ VASC Center for Vascular Research, München, Germany.
⁷ Cardioangiologic Center Bethanien CCB, Frankfurt am Main, Germany.

PMID: 39791345
DOI: 10.1024/0301-1526/a001174

Abstract

Background: Dual-pathway inhibition (DPI) with aspirin and rivaroxaban exhibited a net clinical benefit for patients with cardiovascular disease in the randomized COMPASS trial. The non-observational, international XATOA registry showed that the COMPASS results can be reproduced in clinical practice in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). Here we report patient characteristics and clinical outcomes for the subgroup of German PAD patients of the XATOA registry and compare them to COMPASS PAD patients. Patients and methods: XATOA was an international prospective registry of patients receiving DPI with a mean follow-up period of 15 months. The subgroup of German patients with PAD in XATOA comprised 1,819 patients, of which 925 patients (50.9%) had only PAD and 894 patients (49.1%) had both CAD and PAD. Patient characteristics such as prior medical history and prior medications as well as clinical outcomes such as incidences of major adverse limb events (MALE), major adverse cardiovascular events (MACE) and major bleeding events were assessed. Results: DPI was well-tolerated in clinical practice. Patient characteristics and clinical outcomes especially for patients with only PAD differed from characteristics and outcomes of the overall German XATOA population as well as the PAD subgroup of COMPASS. Patients with only PAD were markedly less supplied with lipid-lowering agents and betablockers. Incidences of MALE were high in German PAD patients of XATOA (9.0%) and markedly higher than in the PAD subgroup of COMPASS (1.2%). Incidences of MACE and major bleeding events were lower in German PAD patients of XATOA (MACE: 2.9%, major bleeding: 1.4%) than in PAD patients of COMPASS (MACE: 5.1%, major bleeding: 3.1%). Conclusions: DPI with rivaroxaban and aspirin is well-tolerated by PAD patients in German clinical practice. PAD patients in Germany exhibit different characteristics and show a different clinical outcome profile than PAD patients in COMPASS.

Keywords: Aspirin; Peripheral artery disease; Rivaroxaban; bleeding; dual pathway inhibition.