Network Meta-analysis of the Benefit of Aspirin with Rivaroxaban vs. Clopidogrel for Patients with Stable Symptomatic Lower Extremity Arterial Disease

The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial showed that aspirin, in combination with low dose rivaroxaban, significantly reduced cardiovascular events compared with aspirin alone for the subgroup of patients with symptomatic lower extremity arterial disease (LEAD). Some of this benefit was mitigated by increased major bleeding events in the aspirin with rivaroxaban arm. 1 Twenty-one years before COMPASS, the Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE) randomised trial showed that clopidogrel also significantly reduced cardiovascular events over aspirin without increasing major bleeding in a similar cohort. No other antithrombotic regimen has ever been shown to have a significant net clinical benefit over aspirin for patients with symptomatic LEAD.