# Acute ledischemie en vorapaxar bij perifeer arterieel vaatlijden: TRA 2°P-TIMI 50-resultaten

*geplaatst 2016-03-08 · Algemeen · Circulation · doi 10.1161/CIRCULATIONAHA.115.019355 · https://hartvaat.nl/2016/03/08/acute-ledischemie-en-vorapaxar-bij-perifeer-arterieel-vaatlijden-tra-2p-timi-50-/*

Analyse van de TRA 2°P-TIMI 50-trial naar de incidentie en uitkomsten van acute ledischemie bij patiënten met perifeer arterieel vaatlijden behandeld met vorapaxar. Onderzoekt de beschermende werking van PAR-1-antagonisme.

## English: Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease: Results From the Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50).

This TRA 2°P-TIMI 50 analysis characterized the incidence and outcomes of acute limb ischemia in peripheral artery disease patients, evaluating whether vorapaxar (a PAR-1 antagonist) reduces this devastating complication.

## Abstract (original, from the publication)

BACKGROUND: Patients with peripheral artery disease (PAD) are at heightened risk of acute limb ischemia (ALI), a morbid event that may result in limb loss. We investigated the causes, sequelae, and predictors of ALI in a contemporary population with symptomatic PAD and whether protease-activated receptor 1 antagonism with vorapaxar reduced ALI overall and by type. METHODS AND RESULTS: The Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50) was a randomized, double-blind, placebo-controlled trial of vorapaxar in stable patients, including 3787 with symptomatic PAD. ALI was a prespecified adjudicated end point using a formal definition. A total of 150 ALI events occurred in 108 patients during follow-up (placebo 3-year rate, 3.9%; 1.3% annualized). For patients with symptomatic PAD, previous peripheral revascularization, smoking, and the ankle-brachial index were predictive of ALI. The majority of ALI events occurred as a result of surgical graft thrombosis (56%), followed by native vessel in situ thrombosis (27%). Stent thrombosis and thromboembolism caused ALI in 13% and 5%, respectively. Amputation occurred in 17.6% presenting with ALI. Vorapaxar reduced first ALI events by 41% (hazard ratio, 0.58; 95% confidence interval, 0.39-0.86; P=0.006) and total ALI events by 41% (94 versus 56 events; risk ratio, 0.59; 95% confidence interval, 0.38-0.93; P=0.022). The efficacy of vorapaxar was consistent across types of ALI. CONCLUSIONS: In selected patients with symptomatic PAD and without atrial fibrillation, ALI occurs at a rate of 1.3%/y, is most frequently caused by acute bypass graft thrombosis or in situ thrombosis of a diseased vessel, and often results in limb loss. Vorapaxar reduces ALI in patients with symptomatic PAD with consistency across type, including PAD resulting from surgical graft thrombosis and in-situ thrombosis. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00526474.

Auteurs: Marc P Bonaca, J Antonio Gutierrez, Mark A Creager, Benjamin M Scirica, Jeffrey Olin, Sabina A Murphy, Eugene Braunwald, David A Morrow

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.115.019355. Bijgewerkt 2026-07-03T13:25:20Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.