This learning activity is based on a BJC supplement ‘Peripheral artery disease – unmet needs’.
The supplement examined:
- populations with peripheral artery disease (PAD) are at high risk of ischaemic stroke, myocardial infarction and progression of their PAD
- increasing levels of diabetes, hypertension, smoking and end-stage renal disease are leading to an impending global epidemic of PAD
- large numbers of people are living with PAD, with many being asymptomatic and at greater cardiovascular risk than the general population
- recent data suggest half of all chronic total occlusions occurring below the knee are thromboembolic in origin rather than atherosclerotic
- the lack of studies in this area compared to atherosclerotic disease
The publication discussed:
- how healthcare professionals can help avoid this impending health disaster by high quality research and boosting public awareness
- how to diagnose and evaluate those at risk of PAD, and the optimal management of those diagnosed with symptomatic PAD
- this management should involve i) risk factor modification and antithrombotic therapies to improves patient prognosis and ii) improvement of claudication symptoms through exercise therapy, pharmaceutical agents and revascularisation
- the interpretation and implications of the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial, which demonstrated that adding rivaroxaban 2.5 mg twice daily to aspirin 100 mg once daily in patients with PAD reduced major adverse cardiovascular events compared to aspirin alone
- the National Institute for Health and Care Excellence guidance in this area
BJC Learning suggests that two hours of learning on this ‘Learning with reflection’ activity should be equivalent to 2 CPD/CME points
This BJC Learning with reflection activity has a recommended award of two credits for the two hours of learning we estimate you will spend on this activity. You will need to read the following articles that comprise the activity:
Atherosclerotic peripheral artery disease: the growing challenge to improve life and limb
Peripheral artery disease: current diagnosis and management
Combining rivaroxaban with aspirin in stable atherosclerotic vascular disease: clinical evidence from the COMPASS study
After you have read these, you should reflect on what you have learnt and how it will influence your practice, and record this personal reflection in the box beneath the contributors. This will all be saved in the results section of your BJC Learning profile, which you can access at any time. This record can be printed off for revalidation purposes.
Dr Derek Connolly, Consultant Cardiologist and Honorary Senior Lecturer, Institute of Cardiovascular Science, University of Birmingham, and Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust,
Dr Matthew A Popplewell, Academic Clinical Lecturer in Vascular Surgery, University of Birmingham
Dr Ruth A Benson, Academic Clinical Lecturer in Vascular Surgery, University of Birmingham
Mr Owain Fisher, ST5 in Vascular Surgery, University Hospital of Coventry and Warwick
Mr Andrew Garnham, Consultant Surgeon, Black Country Vascular Service, Wolverhampton
Dr Jeffrey A Marbach, Interventional Cardiology Fellow, University of Ottawa Heart Institute, Canada
Dr Aws S Almufleh, Cardiology Fellow and Advanced Heart Failure and Transplant Cardiology Fellow, University of Ottawa Heart Institute, Canada
Dr Derek So, Consultant Interventional Cardiologist, University of Ottawa Heart Institute, Canada
Dr Ann-Yeong Chong, Consultant Interventional Cardiologist, University of Ottawa Heart Institute, Canada
Dr Subramanya G N Upadhyaya, Interventional Fellow, Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust
Vinoda Sharma, Consultant Interventional Cardiologist, Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust
Notes on dosing recommendations from Xarelto® ▼ (rivaroxaban) SmPC (Summary of Product Characteristics)
Xarelto 2.5 mg twice daily, coadministered with a daily dose of 75–100 mg aspirin, is indicated for the prevention of atherothrombotic events in adult patients with coronary artery disease (CAD) or symptomatic peripheral artery disease (PAD) at high risk of ischaemic events.
The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial discussed in this supplement compared both Xarelto 2.5 mg twice-daily plus aspirin and also Xarelto 5 mg twice-daily without aspirin, versus aspirin alone. Results for both comparisons are provided reflecting the original study publication.
Please note, however, that Xarelto 5 mg twice-daily is not a licensed dosage regimen for the above, nor for any other therapeutic indication.