Rivaroxaban Reduces Major Cardiovascular and Limb Events in Patients with CKD and Peripheral Artery Disease with Recent Lower Extremity Revascularization: Insights from VOYAGER PAD
Bibliographic record
Abstract
Background: In the VOYAGER PAD trial, rivaroxaban reduced cardiovascular (CV) and limb ischemic events (HR 0.85 vs placebo, 95% CI 0.76-0.96; p=0.009) in peripheral arterial disease (PAD) patients following lower extremity revascularization (LER). This analysis examines the prespecified subgroup of VOYAGER PAD patients with CKD. Methods: VOYAGER PAD (NCT02504216) randomized 6564 PAD patients following LER to rivaroxaban 2.5 mg twice daily or placebo on a background of aspirin 100 mg daily. The primary endpoint was a composite of acute limb ischemia, major amputation for vascular cause, myocardial infarction, ischemic stroke or CV death. Intention-to-treat analyses utilized Kaplan Meier estimates and Cox proportional-hazards models. Results: Mean baseline eGFR was 75±23 ml/min/1.72m2 with 79, 20, 1 and <1% of patients with CKD stage ≤2, 3, 4 and 5 respectively. During 28-month median follow up, rates of major CV and limb events were higher among patients with more severe CKD (placebo group event rate: 7.4/100 patient-years for eGFR ≥60, 10.0 for eGFR 30-<60 and 9.8 for eGFR 15-<30). Rivaroxaban reduced primary endpoint events with no heterogeneity by eGFR above or below 60 (mostly CKD stage 3)(Figure). Acute limb ischemia and major amputation were significantly reduced among patients with eGFR≥60 (HR 0.77, 95% CI 0.63, 0.94) and <60 (HR 0.55, 95% CI 0.36, 0.86). Major bleeding was infrequent with no heterogeneity by CKD category. Conclusions: Rivaroxaban reduced CV and limb events in patients with CKD, PAD following LER, a particularly high-risk population. Funding: Commercial Support - Bayer
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".