Clinical use of vorapaxar as an emerging antithrombin agent: A literature review of current evidence

In response to the high prevalence of atherothrombotic diseases and the residual risks left by the current antiplatelet therapies, the Food and Drug Administration approved the use of vorapaxar as a secondary prevention of cardiovascular events. Vorapaxar is a novel oral antiplatelet agent that antagonizes protease-activated receptor-1 and inhibits platelet activation without influencing coagulation parameters. In this review, we summarized findings of the main studies and the subanalyses from two pivotal phase III clinical trials of vorapaxar, as well as the results of the available observational studies to assist treatment decision-making of vorapaxar for clinicians. Evidence shows that vorapaxar treatment brings favorable results to patients with myocardial infraction history, peripheral arterial diseases, and acute coronary syndrome and those who underwent coronary artery bypass grafting surgery. Studies supported the efficacy of vorapaxar in treating incident coronary stent thrombosis, acute limb ischemia, and peripheral revascularization which outweighed the safety concern of bleeding. However, vorapaxar should not be administered to patients with prior stroke or transient ischemic attack due to excessive risks of bleeding. Future studies should focus on examining the long-term risks and benefits of vorapaxar on single cardiovascular outcomes and the optimal dosage of vorapaxar for different patient populations.