
In the VOYAGER PAD trial, the effectiveness of rivaroxaban, in combination with aspirin, was studied in patients undergoing lower extremity revascularization (LER) for peripheral artery disease. Rivaroxaban was found to reduce the risk of major cardiac and ischemic limb events by 15%, demonstrating an absolute risk reduction of 0.92% at 6 months and 1.04% at 3 years. In endovascular-treated patients, the risk of acute limb ischemia or major amputation was reduced by 30%, with an absolute risk reduction of 1.0% at 6 months and 2.0% at 3 years compared to aspirin alone. However, there was a significant increase in Thrombolysis in Myocardial Infarction major bleeding in the rivaroxaban and aspirin group for the endovascular cohort. Although there was an increased mortality with rivaroxaban in endovascular-treated patients, this was isolated to specific regions. Overall, the data supports the use of rivaroxaban in addition to aspirin or dual antiplatelet therapy after endovascular intervention for symptomatic peripheral artery disease, as it effectively reduces ischemic risks.
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