However, like most drugs intended to reduce the risk of clots and treat heart attacks, vorapaxar also increased the risk of dangerous bleeding, leading the researchers to conclude that clinicians will need to carefully assess which groups of patients will benefit from the treatment. The drug appeared to be most effective for patients who were younger than 75 years, with no history of stroke and a body weight greater than 60kg. For this group, the researchers suggest that the cardiovascular advantages of long-term vorapaxar treatment are likely to outweigh the adverse health risks to the patient associated with a higher likelihood of bleeding.
Vorapaxar is a type of drug known as a platelet inhibitor, because it halts the reaction of platelets in the blood which can lead to blood clot formation and heart attack or stroke. While platelet inhibitors (in conjunction with aspirin) currently form part of the standard treatment in the year following a heart attack, this is the first study to demonstrate that giving an antiplatelet therapy in addition to aspirin is beneficial for longer-term secondary prevention of heart attacks.
According to lead author Dr Benjamin Scirica of the Brigham and Women's Hospital in Boston, USA, "To our knowledge, our study is the first to show a benefit of adding intense antiplatelet treatment to aspirin for long-term secondary prevention of thrombotic events in patients who have had a heart attack."
Dr Stefan James of Uppsala University in Sweden, author of a linked Comment accompanying the Article, adds that: "The results of this work give further support for the benefit of adding more potent long term anti thrombotic therapy for patients who have previously had a heart attack. However, the challenge – as with all strategies of this type – is to weigh the benefit against the increased bleeding risk."*
Dr Benjamin Scirica, Brigham and Women's Hospital, Boston, USA T) +1 617 278 0145 E) bscirica@partners.org
Dr Stefan James, Uppsala University, Uppsala, Sweden T) +46 705 944 404 E) stefan.james@ucr.uu.se
NOTES TO EDITORS:
*Quote direct from author and cannot be found in text of Comment.
The Lancet