title: Unmet needs in the management of acute myocardial infarction: role of novel protease-activated receptor-1 antagonist vorapaxar.
abstract: Platelet activation with subsequent aggregation is a complex process leading to thrombus formation, which remains a key component for atherothrombotic manifestations, in particular myocardial infarction. Therefore, antiplatelet therapies are pivotal for the treatment of these patients. Current oral antiplatelet therapies used for secondary prevention of ischemic recurrences include aspirin and adenosine diphosphate P2Y12 platelet-receptor antagonists. However, despite these therapies, patients who have experienced a myocardial infarction remain at risk for ischemic recurrences. Therefore, more aggressive secondary prevention measures have been an area of research, including identifying additional targets modulating platelet-activation and -aggregation processes. Among these, thrombin-mediated platelet activation via protease-activated receptors (PARs) has been subject to extensive clinical investigation. Several PAR-1 receptor antagonists have been developed. However, vorapaxar is the only one that has completed large-scale clinical investigation. The present manuscript will provide an overview on the role of thrombin-mediated signaling, the impact of PAR-1 blockade with vorapaxar on ischemic and bleeding outcomes, and the potential role for vorapaxar in clinical practice.
authors.affiliation: University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.
authors.forename: Jung Rae
authors.initials: JR
authors.lastname: Cho
authors.affiliation: University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Rollini
authors.affiliation: University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Franchi
authors.affiliation: University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Ferrante
authors.affiliation: University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
mesh_terms: D000818:Animals; D001792:Blood Platelets / Q000187:drug effects* / Q000201:enzymology; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007783:Lactones / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D058990:Molecular Targeted Therapy; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011725:Pyridines / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D044463:Receptor, PAR-1 / Q000097:blood; D012307:Risk Factors; D055502:Secondary Prevention; D015398:Signal Transduction / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D007783:Lactones; D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; D044463:Receptor, PAR-1; C530299:vorapaxar
keywords: antiplatelet agent; platelet aggregation; protease-activated receptor 1; vorapaxar
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