Abstract
Vorapaxar (Zontivity®), is a first-in-class protease-activated receptor-1 antagonist, is approved for use with standard care antiplatelet therapy for the secondary prevention of cardiovascular thrombotic events in patients with a history of myocardial infarction or with peripheral artery disease. In the TRA 2°P-TIMI 50 trial, oral vorapaxar 2.08 mg once daily + standard antiplatelet therapy significantly reduced the risk of major cardiovascular events in stable patients with established atherosclerosis; however, this treatment benefit was accompanied by an increased risk of bleeding. The net clinical benefit of treatment appears to be greatest in patients with increased atherothrombotic risk, such as those with diabetes.
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References
Gryka RJ, Buckley LF, Anderson SM. Vorapaxar: the current role and future directions of a novel protease-activated receptor antagonist for risk reduction in atherosclerotic disease. Drugs R D. 2017;17(1):65–72.
Cheng JW, Colucci V, Howard PA, et al. Vorapaxar in atherosclerotic disease management. Ann Pharmacother. 2015;49(5):599–606.
Steg PG, Dorman SH, Amarenco P. Atherothrombosis and the role of antiplatelet therapy. J Thromb Haemost. 2011;9(Suppl 1):325–32.
Abtan J, Bhatt DL, Elbez Y, et al. Residual ischemic risk and its determinants in patients with previous myocardial infarction and without prior stroke or TIA: insights from the REACH registry. Clin Cardiol. 2016;39(11):670–7.
Zontivity® (vorapaxar) tablets 2.08 mg (equivalent to 2.5 mg vorapaxar sulfate), for oral use: US prescribing information. Princeton (NJ): Aralez Pharmaceuticals US Inc.; 2016.
Morrow DA, Braunwald E, Bonaca MP, et al. Vorapaxar in the secondary prevention of atherothrombotic events. N Engl J Med. 2012;366(15):1404–13.
Tricoci P, Huang Z, Held C, et al. Thrombin-receptor antagonist vorapaxar in acute coronary syndromes. N Engl J Med. 2012;366(1):20–33.
Morrow DA, Alberts MJ, Mohr JP, et al. Efficacy and safety of vorapaxar in patients with prior ischemic stroke. Stroke. 2013;44(3):691–8.
Magnani G, Bonaca MP, Braunwald E, et al. Efficacy and safety of vorapaxar as approved for clinical use in the United States. J Am Heart Assoc. 2015;4:e001505.
Scirica BM, Bonaca MP, Braunwald E, et al. Vorapaxar for secondary prevention of thrombotic events for patients with previous myocardial infarction: a prespecified subgroup analysis of the TRA 2°P-TIMI 50 trial. Lancet. 2012;380(9850):1317–24.
Bonaca MP, Scirica BM, Creager MA, et al. Vorapaxar in patients with peripheral artery disease: results from TRA2° P-TIMI 50. Circulation. 2013;127(14):1522–9.
Morrow DA, Scirica BM, Fox KA, et al. Evaluation of a novel antiplatelet agent for secondary prevention in patients with a history of atherosclerotic disease: design and rationale for the Thrombin-Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2°P)-TIMI 50 trial. Am Heart J. 2009;158(3):335–41 e3.
Kidd SK, Bonaca MP, Braunwald E, et al. Universal classification system type of incident myocardial infarction in patients with stable atherosclerosis: observations from thrombin receptor antagonist in secondary prevention of atherothrombotic ischemic events (TRA 2°P)-TIMI 50. J Am Heart Assoc. 2016;5(7).
Berg DD, Bonaca MP, Braunwald E, et al. Outcomes in stable patients with previous atherothrombotic events receiving vorapaxar who experience a new acute coronary event (from TRA2°P-TIMI 50). Am J Cardiol. 2016;117(7):1055–8.
Bohula EA, Aylward PE, Bonaca MP, et al. Efficacy and safety of vorapaxar with and without a thienopyridine for secondary prevention in patients with previous myocardial infarction and no history of stroke or transient ischemic attack: results from TRA 2°P-TIMI 50. Circulation. 2015;132(20):1871–9.
Cavender MA, Scirica BM, Bonaca MP, et al. Vorapaxar in patients with diabetes mellitus and previous myocardial infarction: findings from the thrombin receptor antagonist in secondary prevention of atherothrombotic ischemic events-TIMI 50 trial. Circulation. 2015;131(12):1047–53.
Bohula EA, Bonaca MP, Braunwald E, et al. Atherothrombotic risk stratification and the efficacy and safety of vorapaxar in patients with stable ischemic heart disease and previous myocardial infarction. Circulation. 2016;134(4):304–13.
Frampton JE. Vorapaxar: a review of its use in the long-term secondary prevention of atherothrombotic events. Drugs. 2015;75(7):797–808.
Acknowledgements
The review was updated from Drugs 2015;75(7):797–808 [18], and was reviewed by: R. Corbalan, Cardiovascular Division, Pontificia Universidad Catolica de Chile, Santiago, Chile; D. Dürschmied, Department of Cardiology and Angiology I Heart Centre, University of Freiburg, Freiburg, Germany; A. Tello-Montoliu, Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain. During the peer review process, Aralez Pharmaceuticals US Inc. was also offered an opportunity to review this article. Changes resulting from comments received were made on the basis of scientific and editorial merit.
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The preparation of this review was not supported by any external funding.
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K. McKeage, K.A. Lyseng-Williamson and J.E. Frampton are employees of Adis/Springer, are responsible for the article content and declare no conflicts of interest.
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McKeage, K., Lyseng-Williamson, K.A. & Frampton, J.E. Vorapaxar in the long-term secondary prevention of atherothrombotic events: a profile of its use in the USA. Drugs Ther Perspect 33, 254–259 (2017). https://doi.org/10.1007/s40267-017-0407-9
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DOI: https://doi.org/10.1007/s40267-017-0407-9