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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Revascularisation for Symptomatic Peripheral Artery Disease: External Applicability of the VOYAGER PAD Trial

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  • Mette Søgaard
  • Peter B Nielsen
  • Flemming Skjøth
  • Torben B Larsen
  • Nikolaj Eldrup
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OBJECTIVE: In the VOYAGER PAD trial, rivaroxaban 2.5 mg plus aspirin significantly reduced the primary composite efficacy outcome of acute limb ischaemia, major amputation, myocardial infarction, ischaemic stroke, or cardiovascular death compared with aspirin alone. However, patients enrolled in the trial may not reflect patients encountered in daily clinical practice. This study described the proportion of patients eligible for VOYAGER PAD within the nationwide Danish Vascular Registry (DVR), reasons for ineligibility, and outcomes according to eligibility.

METHODS: In total, 32 911 patients who underwent lower extremity revascularisation for symptomatic peripheral arterial disease (PAD) in the DVR (2000-2016) were identified. Trial inclusion and exclusion criteria were applied, and the three year cumulative incidence of primary and secondary trial outcomes was estimated.

RESULTS: Altogether, 27.1% of patients with PAD in the DVR were "VOYAGER eligible". Of those not included, 30.7% had at least one exclusion criterion ("VOYAGER excluded"), and an additional 42.3% did not fulfil the inclusion criteria ("VOYAGER not included"). The main reasons for exclusion were atrial fibrillation (32.3%), poorly regulated hypertension (20.6%), requirement for long term dual antiplatelet therapy (10.9%), cytochrome P450 inhibitors or inducers (9.7%), and renal failure (9.3%). The three year rate of the primary efficacy outcome was 10.08 per 100 person years among the "VOYAGER eligible", 16.32 among "VOYAGER excluded", and 6.98 among the "VOYAGER not included". For the primary safety outcome of thrombolysis in myocardial infarction (TIMI) major bleeding, rates were 2.24, 3.76, and 1.17, respectively. Rates of secondary endpoints were also consistently lower for patients who did not meet the inclusion criteria (predominantly due to central aorto-iliac procedures) and highest for "VOYAGER excluded" patients. "VOYAGER eligible" patients experienced a higher cumulative incidence of most endpoints than patients enrolled in the control arm of the VOYAGER PAD trial.

CONCLUSION: Among patients in routine clinical practice, 27.1% were eligible for the VOYAGER PAD trial. These patients were older, had more severe vascular symptoms, higher bleeding risk, and worse prognosis than trial participants.

Original languageEnglish
JournalEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
Volume63
Issue number2
Pages (from-to)285-294
Number of pages10
ISSN1078-5884
DOIs
Publication statusPublished - Feb 2022

Bibliographical note

Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

    Research areas

  • Aged, Aspirin/administration & dosage, Clinical Trials, Phase III as Topic, Denmark/epidemiology, Dose-Response Relationship, Drug, Drug Therapy, Combination/adverse effects, Factor Xa Inhibitors/administration & dosage, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Multicenter Studies as Topic, Peripheral Arterial Disease/surgery, Platelet Aggregation Inhibitors/administration & dosage, Postoperative Complications/epidemiology, Randomized Controlled Trials as Topic, Rivaroxaban/administration & dosage, Treatment Outcome, Vascular Surgical Procedures/adverse effects

ID: 79472127