VOYAGER PAD Trial
Details
VOYAGER PAD tested low-dose rivaroxaban plus aspirin in patients with peripheral artery disease after lower-extremity revascularisation — a population at high risk of both major adverse cardiovascular events and major adverse limb events. It supplies the post-revascularisation evidence behind the COR 1A recommendation for dual-pathway inhibition in PAD. (sources/PVD-AHA-2024, rating: very high)
Key Facts
- Population: PAD patients following revascularisation — distinct from COMPASS, which enrolled stable PAD. (sources/PVD-AHA-2024, rating: very high)
- Regimen: rivaroxaban 2.5 mg BID + aspirin 81 mg/day. (sources/PVD-AHA-2024, rating: very high)
- Benefit: reduces both MACE and major adverse limb events (MALE); the regimen is COR 1A in this setting. (sources/PVD-AHA-2024, rating: very high)
- Contraindications: high bleeding risk and prior stroke or intracranial haemorrhage. (sources/PVD-AHA-2024, rating: very high)
- The 2024 ACC/AHA PAD guideline cites VOYAGER PAD, alongside COMPASS, as one of the key trials underpinning its antithrombotic recommendations. (sources/PVD-AHA-2024, rating: very high)
Contradictions / Open Questions
- Post-revascularisation patients are a different risk population. They have a high limb-event risk from restenosis and graft failure as well as a high cardiovascular risk, so the relative contributions of MACE and MALE prevention may differ from stable PAD; the guideline does not stratify the recommendation by baseline bleeding risk beyond the general contraindications. (sources/PVD-AHA-2024, rating: very high)
- The exact event rates are not captured in the wiki's source summaries — the guideline records the direction and recommendation grade, not the trial's hazard ratios; the magnitude of benefit should be read from the primary publication. (sources/PVD-AHA-2024, rating: very high)
- Whether dual-pathway inhibition should start immediately after revascularisation or after a period of DAPT is not resolved by the trial and is a common clinical question.
Connections
- Related to concepts/PAD-Medical-Therapy — antithrombotic therapy after revascularisation
- Related to concepts/CLTI — revascularisation strategy in chronic limb-threatening ischaemia
- Related to entities/Peripheral-Artery-Disease — the treated population
- Related to entities/COMPASS-Trial — the stable-PAD counterpart