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The VOYAGER PAD trial evaluated low-dose rivaroxaban combined with aspirin in patients with peripheral artery disease after lower-extremity revascularization. The combination reduced the composite risk of acute limb ischemia, major amputation for vascular causes, myocardial infarction, ischemic stroke or cardiovascular death compared with aspirin-based therapy alone. The benefit came with more bleeding, reinforcing the need to balance thrombotic protection against hemorrhagic risk. The trial is particularly relevant to vascular surgeons because successful revascularization is only one part of long-term limb preservation. Patients remain at risk for recurrent thrombosis and cardiovascular events even after technically successful treatment. For practice, the study supports consideration of low-dose anticoagulant plus antiplatelet therapy in appropriately selected patients who have an acceptable bleeding risk. Decisions should account for recent procedures, renal function, concomitant medications, prior bleeding and overall cardiovascular profile. VOYAGER PAD has therefore strengthened the evidence for a preventive strategy that protects both the treated limb and the wider vascular system after revascularization.
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The VOYAGER PAD trial evaluated low-dose rivaroxaban combined with aspirin in patients with peripheral artery disease after lower-extremity revascularization. The combination reduced the composite risk of acute limb ischemia, major amputation for vascular causes, myocardial infarction, ischemic stroke or cardiovascular death compared with aspirin-based therapy alone. The benefit came with more bleeding, reinforcing the need to balance thrombotic protection against hemorrhagic risk. The trial is particularly relevant to vascular surgeons because successful revascularization is only one part of long-term limb preservation. Patients remain at risk for recurrent thrombosis and cardiovascular events even after technically successful treatment. For practice, the study supports consideration of low-dose anticoagulant plus antiplatelet therapy in appropriately selected patients who have an acceptable bleeding risk. Decisions should account for recent procedures, renal function, concomitant medications, prior bleeding and overall cardiovascular profile. VOYAGER PAD has therefore strengthened the evidence for a preventive strategy that protects both the treated limb and the wider vascular system after revascularization.
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