Secondary Prevention of Cardiovascular Disease With Vorapaxar: A New Era of 3-Drug Antiplatelet Therapy?

In May 2014, the US Food and Drug Administration (FDA) approved vorapaxar (Zontivity; Merck), an oral antiplatelet agent, for the reduction of thrombotic cardiovascular events in patients with a history of myocardial infarction or peripheral arterial disease.¹ The FDA acted after a 10 to 1 vote in favor of approval in January 2014 by the Cardiovascular and Renal Drugs Advisory Committee; both of us were members of this committee, and one of us (M.J.K.) cast the negative vote. Physicians should understand the benefit-risk balance of vorapaxar: the important benefit is the drug’s potential role in clinical practice as part of a 3-drug antiplatelet regimen for secondary prevention of myocardial infarction and in peripheral artery disease; the serious risk is clinically significant bleeding, including intracranial hemorrhage.