What is the role of vorapaxar (Zontivity) in the treatment of acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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In May 2014, the FDA approved vorapaxar (Zontivity) to reduce the risk of MI, stroke, cardiovascular death, and need for revascularization procedures in patients with a previous MI or peripheral artery disease (PAD). It is a first-in-class antiplatelet medication that is a protease-activated receptor 1 (PAR-1) inhibitor. It is not indicated as monotherapy, but in addition to aspirin and/or clopidogrel.

Approval was based on the Thrombin-Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2°P TIMI-50) trial. Results of the trial (n = 26,499) showed that time to cardiovascular death, MI, stroke, or urgent coronary revascularization was decreased by 13% in patients taking vorapaxar. When coronary revascularization was excluded, the secondary endpoint of cardiovascular death, MI, or stroke was also significantly reduced. [74]

Because of vorapaxar’s antiplatelet effects, moderate or severe bleeding occurred in 3.4% of patients compared with 2.1% in the placebo-treated patients. Intracranial hemorrhage occurred in 0.6% of those taking vorapaxar compared with 0.4% taking placebo. [74]

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