Role of Combination Antiplatelet and Anticoagulation Therapy in Diabetes Mellitus and Cardiovascular Disease

作者：Deepak L. Bhatt, John W. Eikelboom, Stuart J. Connolly, Philippe Gabríel Steg, Sonia Savitri Anand, Subodh Verma, Kelley R. Branch, Jeffrey L. Probstfield, Jackie Bosch, Olga Shestakovska, Michael J. Szarek, Aldo Pietro Maggioni, Petr Widimský, Álvaro Avezum, Rafael Díaz, Basil S. Lewis, Scott D. Berkowitz, Keith A.A. Fox, Lars Rydén, Salim Yusuf, Victor Aboyans, Marco Alings, Patrick Commerford, Nancy Cook‐Bruns, Gilles R. Dagenais, Antonio Dans, Georg Ertl, Camilo Félix, Tomasz Jan Guzik, Randy Hart, Masatsugu Hori, A. K. Kakkar, Katalin Keltai, Mátyás Keltai, J. Kim, Andre L. Lamy, Fernando Tomas Lanas, Yan Liang, Leyang Liu, Eva Lonn, Patricio López‐Jaramillo, Kaj Peter Metsarinne, Paul Moayyedi, Martin James O'Donnell, Alexander N. Parkhomenko, Leopoldo Soares Piegas, Nana V. Pogosova, Mukul Sharma, S. Stoerk, Andrew M. Tonkin, Christian Tobias Torp-Pedersen, George Varigos, Peter B. Verhamme, Dragoş Vinereanu, Khalid Yusoff, Jun Zhu · 发表于：Circulation · 年份：2020 · DOI：10.1161/circulationaha.120.046448 · 被引用次数：157 · 研究领域：Atrial Fibrillation Management and Outcomes、Antiplatelet Therapy and Cardiovascular Diseases、Peripheral Artery Disease Management

Background: Patients with established coronary artery disease or peripheral artery disease often have diabetes mellitus. These patients are at high risk of future vascular events. Methods: In a prespecified analysis of the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies), we compared the effects of rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg daily) versus placebo plus aspirin in patients with diabetes mellitus versus without diabetes mellitus in preventing major vascular events. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included all-cause mortality and all major vascular events (cardiovascular death, myocardial infarction, stroke, or major adverse limb events, including amputation). The primary safety end point was a modification of the International Society on Thrombosis and Haemostasis criteria for major bleeding. Results: There were 10 341 patients with diabetes mellitus and 17 054 without diabetes mellitus in the overall trial. A consistent and similar relative risk reduction was seen for benefit of rivaroxaban plus aspirin (n=9152) versus placebo plus aspirin (n=9126) in patients both with (n=6922) and without (n=11 356) diabetes mellitus for the primary efficacy end point (hazard ratio, 0.74, P =0.002; and hazard ratio, 0.77, P =0.005, respectively, P interaction =0.77) and all-cause mortality (hazard ratio, 0.81, P =0.05; and hazard ratio,...