Impact of selective platelet inhibition in reducing cardiovascular risk – role of vorapaxar

Figures & data

Table 1 Clinical trials of vorapaxar used in patients with cardiovascular diseases

	TRACER^Citation24 (n=12,944)	TRA 2P-TIMI 50^Citation32 (n=26,449)
Study design	Randomized, double blinded, controlled	Randomized, double blinded, controlled
Intervention	Vorapaxar 40 mg loading dose followed by 2.5 mg daily versus placebo	Vorapaxar 2.5 mg daily versus placebo
Patient population	Patients presented NSTE-ACS within past 24 hours	Patients with a history of atherosclerosis (MI or ischemic stroke within 2 weeks–12 months or PAD associated with intermittent claudication and an ankle brachial index <0.85 or previous revascularization for limb ischemia)
Primary end points	Composite of cardiovascular death, MI, stroke, and recurrent ischemia with urgent coronary revascularization	Composite of death from cardiovascular causes, MI, or stroke
Results	Primary end points: placebo 19.9%, vorapaxar 18.5% (HR 0.92, 95% CI 0.85–1.01, P=0.07)	Primary end points: placebo 10.5%, vorapaxar 9.3% (HR 0.87, 95% CI 0.8–0.94, P<0.001)
	GUSTO moderate or severe bleeding: placebo 5.2%, vorapaxar 7.2% (HR 1.35, 95% CI 1.16–1.58, P<0.05)	GUSTO moderate or severe bleeding: placebo 2.5%, vorapaxar 4.2% (HR 1.66, 95% CI 1.43–1.93, P<0.05)
	Clinically significant TIMI bleeding: placebo 14.6%, vorapaxar 20.2% (HR 1.43, 95% CI 1.31–1.57, P<0.05)	Clinically significant TIMI bleeding: placebo 0.5%, vorapaxar 1% (HR 1.94, 95% CI 1.39–2.70, P<0.05)
	ICH: placebo 0.2%, vorapaxar 1.1% (HR 3.39, 95% CI 1.78–6.48, P<0.05)	ICH: placebo 0.5%, vorapaxar 1% (HR 1.94, 95% CI 1.39–2.70, P<0.001)

Notes: P-values calculated using Cox proportional-hazards model.

Abbreviations: TRACER, Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome; TRA 2P-TIMI 50, Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events – Thrombolysis in Myocardial Infarction 50; NSTE-ACS, Non-ST-segment elevation acute coronary syndrome; MI, myocardial infarction; PAD, peripheral arterial disease; HR, hazard ratio; CI, confidence interval; GUSTO, Global Use of Strategies to Open Occluded Arteries; TIMI, thrombolysis in myocardial infarction; ICH, intracranial hemorrhage.

TricociPHuangZHeldCTRACER InvestigatorsThrombin receptor antagonist vorapaxar in acute coronary syndromesN Engl J Med20123661203322077816

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MorrowDABraunwaldEBonacaMPTRA 2P–TIMI 50 Steering Committee and InvestigatorsVorapaxar in the secondary prevention of atherothrombotic eventsN Engl J Med2012366151404141322443427

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