A Century Later, An Improvement on Daily Aspirin

A collaborative effort spanning 33 countries has found a better daily regimen for survivors of heart attack and stroke.

 |  Transcript [PDF]

Many patients with a history of heart attack or stroke are prescribed daily aspirin to prevent dangerous blood clots from forming in their bodies. After almost a century of being the gold standard, researchers at the Population Health Research Institute (PHRI) want to know if it’s possible to improve on aspirin.

To learn more, PHRI is part of a massive global randomized trial called COMPASS: Cardiovascular Outcomes in People using Anticoagulation Strategies. Patients are enrolled in 33 countries, spread out across over 600 sites.

“COMPASS is a study where we took people with evidence of vascular disease — stroke, or peripheral artery disease, or a heart attack,” says cardiologist Salim Yusuf. “These people are at risk of future events, even though they may be getting aspirin.”

Because aspirin alone may not be enough for all patients, COMPASS is looking to prove whether drug combinations may be a better option.

“The exciting part is we certainly found that the low-dose rivaroxaban used together with aspirin was superior to aspirin alone,” adds cardiologist Sonia Anand.

“That’s the first time we have a therapy that prevents both cardiovascular complications and limb complications. Nobody wants to have an amputation, suffer a stroke, or die because of those causes. And now, with this therapy, we can significantly reduce the chances of that happening.”

Harnessing the collaborative efforts of so many institutions worldwide is what makes this proof possible.

“No one person does a trial like this,” says hematologist John Eikelboom. “This involves incredible resources. It involves a large number of groups. There are countless scientists that have been working, labouring in the background, rarely recognized. There is then the collaboration between industry, academia, regulators. We need leaders in each country: 33 leaders in 33 countries. We end up with a list of thousands of collaborators.”

It’s not just the power to collect the necessary data, it’s also all the minds that help form a coherent story from those data. In the case of the COMPASS study, the combination treatment was such a clear improvement over aspirin alone that it has changed regulatory approval and clinical practice around the world for the first time in almost 100 years.

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