Vorapaxar: thrombin receptor antagonist for prevention of stent thrombosis

Vorapaxar: thrombin receptor antagonist for prevention of stent thrombosis Vorapaxar is a new thrombin receptor antagonist which has been shown to reduce cardiovascular deaths and recurrent thrombotic events in patients with stable atherosclerotic vascular disease. This effect has been documented when added to standard anti platelet therapy. Vorapaxar is an orally active protease-activated-receptor-1 (PAR-1) antagonist capable of inhibiting thrombin induced platelet activation. Thrombin activates platelets through PAR-1 and PAR-4. PAR-1 is more important in the sense that it is activated by lower concentrations of thrombin than PAR-4 and mediates a more rapid response. TRACER trial [Tricoci P et al. Thrombin-receptor antagonist vorapaxar in acute coronary syndromes. N Engl J Med. 2012;366:20-33] showed that adding vorapaxar to standard therpay did not reduce the composite end point of cardiovascular death, myocardial infarction, stroke, hospitalization for recurrent ischemia and urgent coronary revascularization in acute coronary syndrome. At the same time there was a significant increase in major bleeding including intracranial hemorrhage. In this trial vorapaxar did not have an effect on stent thrombosis. A recent study published in JACC [Bonaca MP et al. Coronary Stent Thrombosis With Vorapaxar Versus Placebo: Results From the TRA 2°P-TIMI 50 Trial. J Am Coll Cardiol. 2014;64:2309-2317] has shown that definite stent thrombosis as per Academic Research Consortium criteria ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Angiography and Interventions Coronary Interventions Source Type: blogs