title: Role of Vorapaxar After Coronary Revascularization.
abstract: We aim to evaluate the potential benefit and risk of addition of vorapaxar to standard medical therapy in patients who underwent coronary revascularization with either percutaneous coronary revascularization or coronary artery bypass graft surgery. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at clinicaltrials.gov for randomized control trials evaluating the safety and efficacy of vorapaxar in patients who underwent coronary revascularization procedures with either percutaneous coronary revascularization or coronary artery bypass graft surgery. Event rates were compared using a Forest plot of relative risk using a random-effects model. The 5 studies (n = 24,025) that met all criteria were included in the final analysis. After coronary revascularization procedures, addition of vorapaxar to standard medical therapy was associated with reduction in the risk of myocardial infarction (MI; risk ratio 0.83 [0.75 to 0.92]) and ischemic stroke (0.011 [0.007 to 0.016]); however, it also resulted in significant increase risk of hemorrhagic stroke (1.57 [1.01 to 2.44]) and Thrombolysis In Myocardial Infarction major and minor bleeds (1.36 [1.07 to 1.70]). There was no significant difference in the risk of cardiovascular mortality (0.90 [0.73 to 1.09]), repeat revascularization (0.78 [0.23 to 2.70]), and stent thrombosis (0.95 [0.62 to 1.45]) in the vorapaxar and control groups. In conclusion, after coronary revascularization procedures, addition of vorapaxar to standard medical therapy was associated with reduction in the risk of MI and ischemic stroke and increase in risk of hemorrhagic stroke and Thrombolysis In Myocardial Infarction major and minor bleeds.
authors: Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, New York, New York. Electronic address: abhisheksharma4mamc@gmail.com.
authors: Abhishek
authors: A
authors: Sharma
authors: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana.
authors: Carl J
authors: CJ
authors: Lavie
authors: Division of Cardiology, Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Boulevard de l'Hôpital, Paris, France; Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France.
authors: Gérard
authors: G
authors: Helft
authors: Division of Cardiovascular Diseases, St. Luke's-Roosevelt Hospital Center of the Mount Sinai Health System, New York, New York.
authors: Saurav
authors: S
authors: Chatterjee
authors: Department of Medicine, Maimonides Medical Center, New York, New York.
authors: Sunny
authors: S
authors: Goel
authors: Department of Medicine, James J. Peters Veterans Affairs Medical Center, Mount Sinai School of Medicine, New York, New York.
authors: Aakash
authors: A
authors: Garg
authors: Division of Cardiology, Texas Tech University, El Paso, Texas.
authors: Debabrata
authors: D
authors: Mukherjee
authors: Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, New York, New York.
authors: Jonathan D
authors: JD
authors: Marmur
mesh_terms: D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use*; D018570:Risk Assessment
chemical_list: D007783:Lactones; D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C530299:vorapaxar