Is vorapaxar effective in managing atherosclerosis?

This study examined the safety and effectiveness of the drug, vorapaxar (Zontivity), in reducing the risk of complications caused by atherosclerosis. 

Atherosclerosis is the build-up of cholesterol, fat, and calcium as plaques in the walls of arteries. The plaques can rupture when there are sudden changes in blood flow or blood pressure (such as in intense exertion or emotional stress). The ruptured plaque leads to the formation of a blood clot, which can quickly grow and block the artery.

The tissues (e.g. heart muscle or brain) that are nourished by the blocked artery will be suddenly deprived of oxygen and nutrients, leading to cell death. Atherosclerosis leads to cardiovascular events such as heart attacks, ischemic strokes, and acute coronary syndrome (sudden reduced blood flow to the heart that causes chest pain or pressure).

Treatment for atherosclerosis includes drugs that prevent blood clots, such as Vorapaxar (Zontivity). 

This study reviewed past clinical trials to examine the use of vorapaxar (Zontivity) in treating atherosclerosis. Two large clinical trial studies were used in this review and the effectiveness and safety of vorapaxar was evaluated.

The first study included nearly 13,000 patients with acute coronary syndrome. They found that when given with standard anti-blood clotting drugs such as Aspirin, vorapaxar did not significantly protect against heart attacks, stroke or death caused by cardiovascular events,

However, a second study was carried out in patients with stable atherosclerotic plaques and a history of either heart attack, stroke or peripheral arterial disease (atherosclerosis in limb arteries). In this three-year study in over 26,000 patients, vorapaxar was added to standard treatment (aspirin and/or clopidogrel (Plavix)) and significantly reduced the occurrence of death, heart attacks and ischemic stroke.

A side effect of a drug like vorapaxar designed to stop blood from clotting is excessive internal bleeding if a blood vessel ruptured. In both studies vorapaxar was shown to increase the risk of bleeding compared to placebo. Furthermore, an increased occurrence of brain bleeding in the second study led to the exlusion of patients with a prior history of stroke.

The study concluded that vorapaxar (Zontivity), when given with with aspirin and/or clopidogrel is an effective blood clot inhibitor for reducing the risk of cardiovascular events in patients with atherosclerosis. It can be used by patients with stable atherosclerosis and a history of heart attack and peripheral arterial disease but because it increases the risk of bleeding should not be given to patients with a history of stroke.

It is not known whether vorapaxar is safe to use with all other anti-blood clot drugs as it may significantly increase the risk of bleeding. 

If you or someone you know have atherosclerosis, talk to a doctor about the benefits and risks of vorapaxar.