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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn stable patients with a history of atherosclerosis, the investigational protease-activated receptor (PAR)-1 antagonist vorapaxar was effective at reducing further atherothrombotic events. This article presents data from the Thrombin Receptor Antagonist in Secondary Prevention-TIMI 50 Trial [TRA 2P; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00526474\u0026amp;atom=%2Fspmdc%2F12%2F4%2F19.1.atom\u0022\u003ENCT00526474\u003C\/a\u003E] which showed that vorapaxar significantly reduced the risk of deaths from cardiovascular disease, myocardial infarction, or stroke compared with placebo.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn stable patients with a history of atherosclerosis, the investigational protease\u2013activated receptor (PAR)\u20131 antagonist vorapaxar was effective at reducing further atherothrombotic events. David A. Morrow, MD, MPH, Brigham \u0026amp; Women\u0027s Hospital, Boston, Massachusetts, USA, presented data from the Thrombin Receptor Antagonist in Secondary Prevention\u2013TIMI 50 Trial [TRA 2P; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00526474\u0026amp;atom=%2Fspmdc%2F12%2F4%2F19.1.atom\u0022\u003ENCT00526474\u003C\/a\u003E] which showed that vorapaxar significantly reduced the risk of deaths from cardiovascular disease (CVD), myocardial infarction (MI), or stroke compared with placebo.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThis was a worldwide, placebo\u2013controlled, randomized, double\u2013blind study that enrolled 26,449 patients (median age 61 years) with a history of spontaneous MI, ischemic stroke, or peripheral arterial disease (PAD). Subjects were treated with 2.5 mg\/day vorapaxar or placebo, in addition to standard care including aspirin and\/or thienopyridine. Overall, patients were followed for a median of 30 months. However, after a median follow\u2013up of 24 months, treatment was discontinued in patients with a history of stroke due to a higher risk of intracranial hemorrhage (ICH) in that population. The primary efficacy endpoint was a composite of CV death, MI, or stroke. The secondary composite endpoint also included urgent coronary revascularization. The primary safety endpoint was GUSTO moderate or severe bleeding. The primary analysis was conducted on all data from all randomized patients. Additional analyses were conducted on patients without prior stroke and those who qualified with MI (67% of subjects).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the overall population, the primary endpoint occurred in 9.3% of subjects who were randomized to vorapaxar compared with 10.5% of those who were randomized to placebo (HR, 0.87; 95% CI, 0.80 to 0.94; p\u0026lt;0.001). Subjects who qualified with an MI had a significant benefit from treatment with vorapaxar (HR, 0.80; 95% CI, 0.72 to 0.89), as did all patients (MI and PAD cohorts) without a history of stroke (8.3% vs 9.6%; HR, 0.84; 95% CI, 0.76 to 0.93; both p\u0026lt;0.001).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EVoraxapar also significantly reduced the composite secondary endpoint (HR, 0.88; 95% CI, 0.82 to 0.95; p=0.001) and the composite of CV death or MI (HR, 0.86; 95% CI, 0.78 to 0.94; p=0.002). Both GUSTO moderate or severe and clinically significant TIMI bleeding were increased with vorapaxar (HR, 1.66; 95% CI, 1.43 to 1.93; and HR, 1.46; 95% CI, 1.36 to 1.57, respectively), as was ICH (HR, 1.94; 95% CI, 1.39 to 2.70; all p\u0026lt;0.001). There was no difference in fatal bleeding.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe investigators concluded that PAR\u20131 is a valuable novel target and that adding vorapaxar to standard therapy could be an effective treatment for long\u2013term secondary prevention of atherothrombotic events in stable patients with a history of previous MI. However, the benefits for treating patients with PAD remain uncertain, and the risk of ICH in patients with prior stroke is unacceptable with this agent. Careful patient selection is recommended when using vorapaxar [Morrow DA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/4\/19.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznhip\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}