The Way to Select a Suitable Patient Population for Thrombin Receptor Antagonist from the Large Clinical Trial Database of the TRA-2P-TIMI50 Trial
In this issue of Circulation, Cavender et al presented an interesting report on the prevention of cardiovascular (CV) events in patients with prior myocardial infarction (MI) with and without diabetes mellitus (DM) using Vorapaxar, a new class antiplatelet agent of thrombin receptor (protease activated receptor: PAR)-1 antagonist.1,2 Platelet cells are known to play crucial roles in both hemostasis and pathological thrombus formation.3 The efficacy and safety of various antiplatelet agents were tested in many clinical settings including "acute coronary syndrome",4, 5 "cerebrovascular, coronary and peripheral arterial diseases",6 "stable out-patients with atherothrombosis"7 and so on. The complicated and yet to be clarified quantitative relationship between activation/inhibition of each receptor on platelet cells (as shown in Figure 18-10) and the onset of thrombotic and bleeding events makes it difficult to predict the best suitable antiplatelet intervention in individual patients using a constructive logic.11 Thus, the Evidence-based approach is currently the only available tool to test scientific hypothesis in clinical medicine.
- Received February 5, 2015.
- Accepted February 11, 2015.