The Medical Letter on Drugs and Therapeutics
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Vorapaxar (Zontivity) for Prevention of Thrombotic Cardiovascular Events

The FDA has approved vorapaxar (Zontivity – Merck), an oral protease-activated receptor-1 (PAR-1) antagonist, for use with aspirin and/or clopidogrel to reduce the risk of thrombotic cardiovascular events in patients with peripheral arterial disease or a history of myocardial infarction (MI). It is the first PAR-1 antagonist to be approved by the FDA.

STANDARD ANTIPLATELET THERAPY — Aspirin plus clopidogrel, prasugrel, or ticagrelor is the standard of care for prevention of thrombotic cardiovascular events in patients with a history of MI. Prasugrel and ticagrelor are more effective than clopidogrel, but they have been associated with a higher risk of bleeding. In patients with peripheral arterial disease, the standard of care is aspirin alone; if a patient is intolerant to aspirin, clopidogrel can be used.1

ACTIVITY — Thrombin potently ... more      

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