Abstract 18928: Vorapaxar Reduces Coronary Stent Thrombosis: Results From the TRA2P-TIMI 50 Trial
BACKGROUND: Vorapaxar is a novel potent antiplatelet agent that reduces cardiovascular death and recurrent thrombotic events when added to standard antiplatelet therapy. We investigated whether treatment with vorapaxar reduced the rate of coronary stent thrombosis (ST) in stable patients with atherosclerotic vascular disease.
METHODS: TRA2°P-TIMI 50 was a multinational, randomized, double-blind, placebo controlled trial of vorapaxar in stable patients with prior MI, peripheral arterial disease, or stroke. We evaluated the rates of definite ST as adjudicated by a central events committee using Academic Research Consortium (ARC) criteria.
RESULTS: A total of 26,449 patients were randomized with 14,042 (53%) having a history of a coronary stent implantation prior to randomization. An additional 449 patients received a coronary stent during the trial. The rate of ARC definite stent thrombosis in placebo group at three years was 1.4% (0.47% per year) in those with a coronary stent implanted prior to or during the trial (Fig 1A). Vorapaxar reduced ARC definite ST (1.1% at three years, 0.36% per year, HR 0.71, p=0.040, figure 1B). In those patients who qualified for the trial with MI (17,779, 77% on aspirin and thienopyridine), 76% had a history of prior stenting or a new stent during the trial (13,489). The rate of ST was similar (0.47% per year placebo, Fig 1A) with a consistent reduction with vorapaxar (HR 0.71, p=0.046, Fig 1B).
CONCLUSIONS: The rate of ARC definite ST in stable patients with coronary stents, the majority of whom were receiving DAPT, was approximately 1.4% at three years. Vorapaxar significantly reduced ARC definite ST in stable patients with atherosclerotic vascular disease and history of coronary stent on standard antiplatelet therapy.
- © 2013 by American Heart Association, Inc.