We read with interest the paper by Lopes et al reporting data about ‘best medical treatment’ (BMT) in patients admitted to a vascular surgery department. BMT was defined as treatment with antithrombotic and lipid-lowering treatment and, when appropriate, antihypertensive, and anti-diabetic drugs. However, the anti-thrombotic drug chosen was not specified and the reasons for not being on BMT were not detailed. Unlike in clinical trials, real-world patients can present a significant number of uncontrollable variables that could influence both therapeutic decisions and outcomes.
We would like to call attention to a topic only briefly mentioned by the authors – the COMPASS trial strategy.
In 2017, the COMPASS trial showed that using aspirin plus low-dose rivaroxaban in patients with stable atherosclerotic vascular disease reduced cardiovascular death, stroke, or myocardial infarction by 24%. Even when considering the bleeding risk, combination therapy had a net clinical benefit of 20%.

Full paper available here.