Commentary on: Anand SS, Bosch J, Eikelboom JW, et al on behalf of the COMPASS Investigators. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2018;319:219–229.

Context People with peripheral vascular disease are at high risk of vascular events and major adverse limb events. Use of antiplatelet therapy is effective at reducing this risk. Other antithrombotic strategies that have been tested, such as use of anticoagulation, dual antiplatelet therapy or novel antiplatelet agents, have not been found to be superior to single antiplatelet therapy. The new oral factor Xa inhibitors such as rivaroxaban have been shown to be at least as effective as vitamin K antagonists in preventing thromboembolic events in atrial fibrillation,1 and offer a potential alternative strategy, either in addition to, or instead of, a single antiplatelet agent.