82 Would Vascular surgeon adopt the COMPASS as their post-carotid endarterectomy (CEA) long-term antithrombotic drug regimen?

Abstract Introduction The COMPASS trial1 demonstrated that for patients with an atherosclerotic burden, low-dose rivaroxaban with aspirin reduces Major Adverse Cardiovascular Events (MACE) more effectively than aspirin alone. 50% of CEA patients die from MACE, but COMPASS has not been widely adopted as a post-CEA antithrombotic regimen. We assess vascular surgeons’ views on this. Methods A questionnaire emailed to UK vascular surgeons determined their present long-term post-CEA antithrombotic regimen and views on changing to COMPASS within and without the confines of a trial. This was assessed on a 10-point Lockhart score (0-10, with 10 strongly in favour). Results 181 surgeons responded, of which 91(50%) were teaching hospital-based, and 53 (29%) regularly attended a stroke MDT. Presently 146(81%) prescribe clopidogrel and 16(9%) aspirin, 14(7%) DAPT with 5(3%) COMPASS. The Lockhart score mode to adopting COMPASS now was 5(range 0-10). Of the 122 expressing a reason not to implement COMPASS, 65% reported a lack of evidence, 22% side-effects, especially bleeding and 10% compliance. However, more consultants would consider COMPASS within the confines of a trial (Lockhart score mode 10 (range 1-10) p<0.01). 97% of consultants would submit patients to a trial, with 46% entering >20 patients yearly. The main concern with such a trial was the need to include a clopidogrel arm. Conclusion With no improvement to the post-CEA antithrombotic drug regime for 25 years, UK vascular surgeons appear prepared to consider replacing their present drugs with COMPASS, but only within the confines of a trial. 1. DOI:10.1056/NEJMoa1709118