{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T08:02:55Z","timestamp":1781164975122,"version":"3.54.1"},"reference-count":5,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The Clopidogrel and Acetylsalicylic Acid in Bypass Surgery for Peripheral Arterial Disease (CASPAR) trial is the only large, double\u2010blind, placebo\u2010controlled trial of dual antiplatelet therapy (DAPT) versus aspirin in patients with peripheral artery disease (PAD) after lower extremity revascularization (LER). The trial was neutral for index\u2010graft occlusion\/revascularization, amputation or death (hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.78\u20131.23, <jats:italic>p<\/jats:italic>\u2009=\u2009.87) with an excess of global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries moderate or severe bleeding (HR 2.84, 95% CI 1.32\u20136.08, <jats:italic>p<\/jats:italic>\u2009=\u2009.007).<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis and Methods<\/jats:title><jats:p>VOYAGER\u2010PAD demonstrated that rivaroxaban significantly reduces acute limb ischemia (ALI), major amputation, myocardial infarction (MI), stroke and CV death but increased bleeding. The relative efficacy and safety of rivaroxaban in a CASPAR like population and for similar outcomes is unknown. The current analysis is a post\u2010hoc exploratory analysis of a \u201cCASPAR like\u201d composite of ALI, unplanned index limb revascularization (UILR), amputation or CV death in surgical patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the 2185 who underwent surgical LER, rivaroxaban reduced the CASPAR endpoint at 1 (HR 0.76, 95% CI 0.62\u22120.95, <jats:italic>p<\/jats:italic>\u2009=\u2009.0133) and 3 years (HR 0.84, 95% CI 0.71\u22121.00, <jats:italic>p<\/jats:italic>\u2009=\u2009.0461, Figure). There were similar reductions in composites of ALI, amputation or CV death (HR\u00a00.79, <jats:italic>p<\/jats:italic>\u2009=\u2009.0228) and ALI, UILR, amputation, MI, IS or CV death (HR\u00a00.85, <jats:italic>p<\/jats:italic>\u2009=\u2009.0410).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The combination of rivaroxaban and aspirin significantly reduces ischemic outcomes in patients with PAD after LER. Although no formal head\u2010to\u2010head comparison exists, in a similar population and for similar outcomes, this regimen demonstrated benefit where trials of DAPT were neutral. These data suggest that factor Xa inhibition may provide specific benefits in this population and that DAPT should not be considered a proven substitution.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23926","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T15:27:49Z","timestamp":1666020469000},"page":"1143-1146","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Efficacy and safety of rivaroxaban versus placebo after lower extremity bypass surgery: A post hoc analysis of a \u201cCASPAR like\u201d outcome from VOYAGER PAD"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9860-3584","authenticated-orcid":false,"given":"Marc P.","family":"Bonaca","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Cardiology University of Colorado School of Medicine Aurora Colorado USA"},{"name":"CPC Clinical Research Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Szarek","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology University of Colorado School of Medicine Aurora Colorado USA"},{"name":"CPC Clinical Research Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Sebastian","family":"Debus","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Vascular Surgery \u2013 Angiology \u2013 Endovascular Therapy University of Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark R.","family":"Nehler","sequence":"additional","affiliation":[{"name":"CPC Clinical Research Aurora Colorado USA"},{"name":"Department of Surgery University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manesh R.","family":"Patel","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Division of Cardiology Duke University Medical Center Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia S.","family":"Anand","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton Health Sciences McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Muehlhofer","sequence":"additional","affiliation":[{"name":"Bayer AG Research &amp; Development Wuppertal Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Berkowitz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology University of Colorado School of Medicine Aurora Colorado USA"},{"name":"CPC Clinical Research Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd P.","family":"Haskell","sequence":"additional","affiliation":[{"name":"Janssen Research and Development Raritan New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert M.","family":"Bauersachs","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, and Center for Thrombosis and Hemostasis University of Mainz Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010746"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2000052"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.04.027"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.054835"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.050465"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.23926","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/clc.23926","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.23926","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T16:27:09Z","timestamp":1692462429000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.23926"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,17]]},"references-count":5,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1002\/clc.23926"],"URL":"https:\/\/doi.org\/10.1002\/clc.23926","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,17]]},"assertion":[{"value":"2022-06-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}