Vorapaxar in Patients With Peripheral Artery Disease Results From TRA2 degrees P-TIMI 50

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Vorapaxar in Patients With Peripheral Artery Disease Results From TRA2 degrees P-TIMI 50

Bonaca, M. P. (author)

Scirica, B. M. (author)

Creager, M. A. (author)

Olin, J. (author)

Bounameaux, H. (author)

Dellborg, Mikael, 1954 (author): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine

Lamp, J. M. (author)

Murphy, S. A. (author)

Braunwald, E. (author)

Morrow, D. A. (author)

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Ovid Technologies (Wolters Kluwer Health), 2013
2013
English.
In: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 127:14

Related links:: https://www.ahajourn...; show more...; https://gup.ub.gu.se...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Background—Vorapaxar is a novel antagonist of protease-activated receptor-1, the primary receptor for thrombin on human platelets that is also present on vascular endothelium and smooth muscle. Patients with peripheral artery disease are at risk of systemic atherothrombotic events, as well as acute and chronic limb ischemia and the need for peripheral revascularization. Methods and Results—The Trial to Assess the Effects of SCH 530348 in Preventing Heart Attack and Stroke in Patients With Atherosclerosis (TRA2°P-TIMI 50) was a randomized, double-blind, placebo-controlled trial of vorapaxar in 26 449 patients with stable atherosclerotic vascular disease (myocardial infarction, stroke, or peripheral artery disease). Patients with qualifying peripheral artery disease (n=3787) had a history of claudication and an ankle-brachial index of <0.85 or prior revascularization for limb ischemia. The primary efficacy end point was cardiovascular death, myocardial infarction, or stroke, and the principal safety end point was Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) bleeding. In the peripheral artery disease cohort, the primary end point did not differ significantly with vorapaxar (11.3% versus 11.9%; hazard ratio, 0.94; 95% confidence interval, 0.78–1.14; P=0.53). However, rates of hospitalization for acute limb ischemia (2.3% versus 3.9%; hazard ratio, 0.58; 95% confidence interval, 0.39–0.86; P=0.006) and peripheral artery revascularization (18.4% versus 22.2%; hazard ratio, 0.84; 95% confidence interval, 0.73–0.97; P=0.017) were significantly lower in patients randomized to vorapaxar. Bleeding occurred more frequently with vorapaxar compared with placebo (7.4% versus 4.5%; hazard ratio, 1.62; 95% confidence interval, 1.21–2.18; P=0.001). Conclusions—Vorapaxar did not reduce the risk of cardiovascular death, myocardial infarction, or stroke in patients with peripheral artery disease; however, vorapaxar significantly reduced acute limb ischemia and peripheral revascularization. The beneficial effects of protease-activated receptor-1 antagonism on limb vascular events were accompanied by an increased risk of bleeding.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

ischemia
outcome assessment
peripheral arterial disease
platelet aggregation inhibitors
vorapaxar
secondary prevention
atherothrombotic events
cardiovascular events
myocardial-infarction
randomized-trials
charisma trial
aspirin
risk
metaanalysis
clopidogrel

Publication and Content Type

ref (subject category)
art (subject category)

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By the author/editor: Bonaca, M. P.; Scirica, B. M.; Creager, M. A.; Olin, J.; Bounameaux, H.; Dellborg, Mikael ...; show more...; Lamp, J. M.; Murphy, S. A.; Braunwald, E.; Morrow, D. A.; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

Articles in the publication: Circulation

By the university: University of Gothenburg

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