Rivaroxaban for Reducing Vascular Event Risks after Limb Revascularization for Peripheral Artery Disease – The VOYAGER PAD Trial with Dr. Marc Bonaca
Peripheral artery disease (PAD) affects some 200 million persons worldwide. Current guidelines recommend antiplatelet monotherapy for the majority of cases, and dual antiplatelet therapy – commonly aspirin and clopidogrel – for endovascular interventions. Even with these, limb events and complications remain high for this subgroup of patients.
Research and practice to date have grown out of findings for PAD subgroups in cardiovascular trials. Although they share risk factors, peripheral artery disease patients are distinct from coronary artery disease populations. The Vascular Outcomes Study of Aspirin Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD or VOYAGER PAD trial recently published in the NEJM puts a focus on this unique group of patients.
In today’s podcast we are joined by Dr. Marc Bonaca to discuss the findings of the recent VOYAGER PAD trial and the use of low-dose rivaroxaban in peripheral artery disease after revascularization.
0:48 – Topic introduction 1:48 – Introduction of panelist 2:45 – Causes of PAD 3:30 – Risk factors for PAD 5:47 – Current treatment options for PAD and why revascularization procedures increase limb risk 10:28 – Goal and design of trial: Choosing to study PAD patients 13:29 – Choosing rivaroxaban as the study drug 16:29 – Engaging multinational trial sites 18:58 – Translating study findings to practice: the target audience 21:57 – Choosing the 5-point composite study outcome: Acute limb ischemia, major amputation of vascular cause, myocardial infarction, ischemic stroke, cardiovascular death 24:35 – Discussion of risk reduction: actual vs relative 26:26 – Safety outcome of bleeding and assessing the risk-benefit ratio 29:02 – Difference in outcome between claudicant and critical limb ischemia patient populations 30:00 – Discussion of future areas of study: graft patency and others 31:53 – Summary of take-home points 32:51 – Conclusion and thanks
The Curbside Consults series complements the foundational information in Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.
Dr. Marc Bonaca Cardiologist and Vascular Medicine Specialist; and an Associate Professor and Director of Vascular Research at the University of Colorado School of Medicine and CPC Clinical Research, Aurora, Colorado. He is the inaugural William R. Hiatt Endowed Chair in Cardiovascular Research of the University of Colorado Anschulz School of Medicine.
Krista is a 2019-2020 editorial fellow at the New England Journal of Medicine. She is from Nassau, Bahamas where she is training in general surgery at the University of the West Indies.