WHAT THIS PAPER ADDS Only 30.1% of patients hospitalised for symptomatic lower extremity artery disease are eligible for rivaroxaban 2.5 mg twice daily plus aspirin, based on the COMPASS or VOYAGER-PAD criteria. These patients have higher rates of ischaemic events than those in these trials. The one year cumulative incidences were 6.0% (95% confidence interval [CI] 4.3 e 8.1) in the COMPASS eligible subset vs. 3.5% (95% CI 2.9 e 4.3) in the COMPASS control arm for major adverse cardiovascular events, and 27.9% (95% CI 19.9 e 38.3) in the VOYAGER-PAD eligible subset vs. 6.0% (95% CI 5.3 e 6.9) in the VOYAGER-PAD control arm for major adverse limb events. This regimen may have greater benefits in the real world population.Objective: The aim of this study was to examine the external applicability of the COMPASS and the VOYAGER-PAD trials in patients with lower extremity artery disease (LEAD) in the real world. Methods: This was a multicentre retrospective analysis of prospectively collected COPART data, a French multicentre registry of patients hospitalised for symptomatic LEAD. The proportion of patients eligible for the combination of rivaroxaban 2.5 mg twice daily plus aspirin based on either COMPASS or VOYAGER-PAD criteria is reported. The one year cumulative incidence of outcomes between eligible and non-eligible patients, as well as eligible patients vs. control arms of the COMPASS (LEAD patient subgroup) and the VOYAGER-PAD trials were compared. Analyses were performed using Cox models. Results: Of 2 259 evaluable patients, only 679 (30.1%) were eligible for a low dose rivaroxaban plus aspirin regimen. Others were not eligible because of the need for anticoagulant (48.5% and 38.9% of patients meeting COMPASS and VOYAGER-PAD exclusion criteria, respectively) or dual antiplatelet therapy use (15.7% and 16.5%, respectively), high bleeding risk (14.4% and 11.6%, respectively), malignancy (26.1% and 21.0%, respectively), history of ischaemic/haemorrhagic stroke (21.1% and 19.8%, respectively), and severe renal failure (13.2% and 10.5%, respectively). COMPASS and VOYAGER-PAD eligible and ineligible patients were at higher risk of ischaemic events than participants in these trials. The one year cumulative incidences were 6.0% (95% CI 4.3 e 8.1) in the COMPASS eligible subset vs. 3.5% (95% CI 2.9 e 4.3) in the COMPASS control arm for major adverse cardiovascular events, and 27.9% (95% CI 19.9 e 38.3) in the VOYAGER-PAD eligible subset vs. 6.0% (95% CI 5.3 e 6.9) in the VOYAGER-PAD control arm for major adverse limb events.