COMPASS Trial Polyvascular Risk Score — Explanation and clinical context This tool implements the COMPASS trial subgroup framework by counting four high-risk features associated with greater absolute benefit from combined rivaroxaban 2.5 mg twice daily plus aspirin versus aspirin alone: polyvascular disease (≥2 vascular beds affected), renal dysfunction (eGFR < 60 mL/min/1.73m²), a history of heart failure, and diabetes mellitus. In the COMPASS prespecified subgroup analyses and subsequent net-clinical-benefit evaluation, increasing numbers of these features correlated with higher absolute event rates and therefore larger absolute risk reduction (ARR) with the combination therapy — leading to substantially lower numbers needed to treat (NNT) in patients with multiple features. Importantly, relative hazard ratios for the treatment effect were broadly similar across subgroups, meaning absolute benefit is primarily driven by baseline risk. Clinically, use of this calculator can help identify patients who, if not at high bleeding risk or otherwise excluded, may derive greater absolute benefit from the COMPASS regimen. This tool does not replace individualized clinical judgment or guideline-based assessment of bleeding risk; it reproduces subgroup results from the COMPASS publications for educational and point-of-care estimation purposes.
Reference:
Steffel J, Eikelboom JW, Anand SS, Shestakovska O, Yusuf S, Fox KAA. The COMPASS trial: net clinical benefit of low-dose rivaroxaban plus aspirin as compared with aspirin in patients with chronic vascular disease. Circulation. 2020;142:40–48. (Subgroup analyses: polyvascular disease, renal dysfunction [eGFR<60], heart failure, diabetes — reported NNTs over 30 months: 0 features NNT 113; 2 features NNT 31; 3 features NNT 12; 4 features NNT 9).
Anand SS, Eikelboom JW, et al. Rivaroxaban plus aspirin versus aspirin in relation to vascular risk in the COMPASS trial. J Am Coll Cardiol. 2019;73:3271–3280.