A Bon VOYAGER for Peripheral Artery Disease

Peripheral artery disease (PAD) is a widespread condition, affecting more than 200 million individuals globally. As a manifestation of systemic atherosclerosis, it significantly increases the risk of serious cardiovascular events such as myocardial infarction, stroke, and death from cardiovascular causes. Furthermore, its presence in the arteries of the extremities can severely impair walking ability and lead to critical limb-threatening ischemia and amputation. Despite its prevalence and severe consequences, PAD is often underrecognized and inadequately treated with appropriate evidence-based therapies aimed at preserving both life and limb. Compared with patients who have known coronary artery disease, those with established PAD alone are notably less likely to receive crucial treatments like antiplatelet drugs, statins, or smoking-cessation interventions.

One contributing factor to this disparity is the relatively limited number of clinical trials for medical therapies specifically designed for PAD, especially when compared with the extensive research conducted for coronary artery disease. The efficacy of lipid-lowering and antithrombotic therapies has largely been demonstrated in broader studies involving diverse populations of patients with stable atherosclerosis, which included subsets of patients with PAD. The VOYAGER PAD trial represents a significant advancement in this area. This trial investigated the benefit of adding rivaroxaban, a direct oral anticoagulant, to aspirin therapy in patients with symptomatic PAD following revascularization. The results indicated a statistically significant reduction in a composite endpoint comprising acute limb ischemia, major amputation due to vascular causes, myocardial infarction, ischemic stroke, or cardiovascular death with the combination therapy. This finding underscores the importance of comprehensive medical therapy, including antithrombotic treatment, in addition to revascularization for patients with PAD.

Peripheral artery disease (PAD) is a widespread condition, affecting more than 200 million individuals globally. As a manifestation of systemic atherosclerosis, it significantly increases the risk of serious cardiovascular events such as myocardial infarction, stroke, and death from cardiovascular causes. Furthermore, its presence in the arteries of the extremities can severely impair walking ability and lead to critical limb-threatening ischemia and amputation. Despite its prevalence and severe consequences, PAD is often underrecognized and inadequately treated with appropriate evidence-based therapies aimed at preserving both life and limb. Compared with patients who have known coronary artery disease, those with established PAD alone are notably less likely to receive crucial treatments like antiplatelet drugs, statins, or smoking-cessation interventions.

One contributing factor to this disparity is the relatively limited number of clinical trials for medical therapies specifically designed for PAD, especially when compared with the extensive research conducted for coronary artery disease. The efficacy of lipid-lowering and antithrombotic therapies has largely been demonstrated in broader studies involving diverse populations of patients with stable atherosclerosis, which included subsets of patients with PAD. The VOYAGER PAD trial represents a significant advancement in this area. This trial investigated the benefit of adding rivaroxaban, a direct oral anticoagulant, to aspirin therapy in patients with symptomatic PAD following revascularization. The results indicated a statistically significant reduction in a composite endpoint comprising acute limb ischemia, major amputation due to vascular causes, myocardial infarction, ischemic stroke, or cardiovascular death with the combination therapy. This finding underscores the importance of comprehensive medical therapy, including antithrombotic treatment, in addition to revascularization for patients with PAD.