Please use this identifier to cite or link to this item: http://hdl.handle.net/2445/49763
Title: Thrombin-receptor antagonist vorapaxar in acute coronary syndromes
Author: Tricoci, Pierluigi
Cequier Fillat, Àngel R.
Held, Claes
Moliterno, David J.
Armstrong, Paul W.
Ambrosio, Giuseppe
Leonardi, Sergio
Keywords: Malalties cardiovasculars
Bypass cardiopulmonar
Plaquetes sanguínies
Medicaments
Cardiovascular diseases
Bypass cardiopulmonary
Blood platelets
Drugs
Issue Date: 5-Jan-2012
Publisher: Massachusetts Medical Society
Abstract: Background: Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation. Methods: In this multinational, double-blind, randomized trial, we compared vorapaxar with placebo in 12,944 patients who had acute coronary syndromes without ST-segment elevation. The primary end point was a composite of death from cardiovascular causes, myocardial infarction, stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization. RESULTS: Follow-up in the trial was terminated early after a safety review. After a median follow-up of 502 days (interquartile range, 349 to 667), the primary end point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate, 18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01; P = 0.07). A composite of death from cardiovascular causes, myocardial infarction, or stroke occurred in 822 patients in the vorapaxar group versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P = 0.02). Rates of moderate and severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95% CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were similar in the two groups. Conclusions: In patients with acute coronary syndromes, the addition of vorapaxar to standard therapy did not significantly reduce the primary composite end point but significantly increased the risk of major bleeding, including intracranial hemorrhage. (Funded by Merck; TRACER ClinicalTrials.gov number, NCT00527943.)
Note: Reproducció del document publicat a: http://dx.doi.org/10.1056/NEJMoa1109719
It is part of: New England Journal of Medicine, 2012, vol. 366, num. 1, p. 20-33
Related resource: http://dx.doi.org/10.1056/NEJMoa1109719
URI: http://hdl.handle.net/2445/49763
ISSN: 0028-4793
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)

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