{"id":"193c593d8b91","type":"article","url":"https://hartvaat.nl/2019/12/07/individueel-levenslang-voordeel-en-bloedingsrisico-van-rivaroxaban-plus-aspirine/","title":"Individueel levenslang voordeel en bloedingsrisico van rivaroxaban plus aspirine: COMPASS","title_en":"Estimating individual lifetime benefit and bleeding risk of adding rivaroxaban to aspirin for patients with stable cardiovascular disease: results from the COMPASS trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz404","source_url":"https://doi.org/10.1093/eurheartj/ehz404","authors":["Tamar I de Vries","John W Eikelboom","Jackie Bosch","Jan Westerink","Jannick A N Dorresteijn","Marco Alings","Leanne Dyal","Scott D Berkowitz","Yolanda van der Graaf","Keith A A Fox","Frank L J Visseren"],"significance":7,"published":"2019-12-07","source_date":"2019-12-07","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/esc-richtlijn-kleplijden-2021/"],"congress":"","summary_en":"This COMPASS analysis estimated the individual lifetime benefit and bleeding risk of adding rivaroxaban to aspirin, providing a personalized risk-benefit framework for dual-pathway inhibition in stable atherosclerotic disease.","created":"2026-07-03T10:28:19Z","updated":"2026-07-03T13:27:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"COMPASS analyse die het geschatte individuele levenslange voordeel en bloedingsrisico van rivaroxaban plus aspirine berekende bij stabiel vaatlijden.","abstract_original":"AIMS: Adding rivaroxaban to aspirin in patients with stable atherosclerotic disease reduces the recurrence of cardiovascular disease (CVD) but increases the risk of major bleeding. The aim of this study was to estimate the individual lifetime treatment benefit and harm of adding low-dose rivaroxaban to aspirin in patients with stable cardiovascular disease. METHODS AND RESULTS: Patients with established CVD from the COMPASS trial (n = 27 390) and SMART prospective cohort study (n = 8139) were used. Using the pre-existing lifetime SMART-REACH model for recurrent CVD, and a newly developed Fine and Gray competing risk-adjusted lifetime model for major bleeding, individual treatment effects from adding low-dose rivaroxaban to aspirin in patients with stable CVD were estimated, expressed in terms of (i) life-years free of stroke or myocardial infarction (MI) gained; and (ii) life-years free from major bleeding lost. Calibration of the SMART-REACH model for prediction of recurrent CVD events in the COMPASS study was good. The major bleeding risk model as derived in the COMPASS trial showed good external calibration in the SMART cohort. Predicted individual gain in life expectancy free of stroke or MI from added low-dose rivaroxaban had a median of 16 months (range 1-48 months), while predicted individualized lifetime lost in terms of major bleeding had a median of 2 months (range 0-20 months). CONCLUSION: There is a wide distribution in lifetime gain and harm from adding low-dose rivaroxaban to aspirin in individual patients with stable CVD. Using these lifetime models, benefits and bleeding risk can be weighed for each individual patient, which could facilitate treatment decisions in clinical practice."}