{"id":"18ffe098608f","type":"article","url":"https://hartvaat.nl/2016/07/26/atherotrombotische-risicostratificatie-en-vorapaxar-bij-stabiel-ischemisch-hartl/","title":"Atherotrombotische risicostratificatie en vorapaxar bij stabiel ischemisch hartlijden en PAV","title_en":"Atherothrombotic Risk Stratification and the Efficacy and Safety of Vorapaxar in Patients With Stable Ischemic Heart Disease and Previous Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anticoagulantia","atherosclerose","bloeddrukbehandeling","dubbele-trombocytenremming","ezetimibe","hartkatheterisatie","harttransplantatie","hfpef","lipidenverlaging","ouderen","pathfinder-trial","perifeer-vaatlijden","rivaroxaban","statines","trombocytenaggregatieremmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.019861","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.019861","authors":["Erin A Bohula","Marc P Bonaca","Eugene Braunwald","Philip E Aylward","Ramon Corbalan","Gaetano M De Ferrari","Ping He","Basil S Lewis","Piera A Merlini","Sabina A Murphy","Marc S Sabatine","Benjamin M Scirica","David A Morrow"],"significance":5,"published":"2016-07-26","source_date":"2016-07-26","image":"","kennis":[],"congress":"","summary_en":"This analysis stratified the efficacy and safety of vorapaxar by atherothrombotic risk in patients with stable ischemic heart disease, identifying which risk profiles derive the greatest net benefit from PAR-1 antagonism.","created":"2026-07-03T10:26:14Z","updated":"2026-07-03T18:38:26Z","licence":"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.","body_markdown":"Analyse naar de werkzaamheid en veiligheid van vorapaxar gestratificeerd naar atherotrombotisch risico bij patiënten met stabiel ischemisch hartlijden en eerder PAV. Onderzoekt gepersonaliseerde antitrombotische therapie.","abstract_original":"BACKGROUND: Patients with stable ischemic heart disease and previous myocardial infarction (MI) vary in their risk for recurrent cardiovascular events. Atherothrombotic risk assessment may be useful to identify high-risk patients who have the greatest potential to benefit from more intensive secondary preventive therapy such as treatment with vorapaxar. METHODS: We identified independent clinical indicators of atherothrombotic risk among 8598 stable, placebo-treated patients with a previous MI followed up for 2.5 years (median) in TRA 2°P-TIMI 50 [Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-TIMI 50]. The efficacy and safety of vorapaxar (SCH 530348; MK-5348) were assessed by baseline risk among patients with previous MI without prior stroke or transient ischemic attack for whom there is a clinical indication for vorapaxar. End points were cardiovascular death, MI, or ischemic stroke and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) severe bleeding. RESULTS: The 9 independent risk predictors were age, diabetes mellitus, hypertension, smoking, peripheral arterial disease, previous stroke, previous coronary bypass grafting, heart failure, and renal dysfunction. A simple integer-based scheme using these predictors showed a strong graded relationship with the rate of cardiovascular death/MI/ischemic stroke and the individual components (P for trend <0.001 for all). High-risk patients (≥3 risk indicators; 20% of population) had a 3.2% absolute risk reduction in cardiovascular disease/MI/ischemic stroke with vorapaxar, and intermediate-risk patients (1-2 risk indicators; 61%) had a 2.1% absolute risk reduction (P<0.001 each), translating to a number needed to treat of 31 and 48. Bleeding increased across risk groups (P for trend<0.01); however, net clinical outcome was increasingly favorable with vorapaxar across risk groups. Fatal bleeding or intracranial hemorrhage was 0.9% with both treatments in high-risk patients. CONCLUSIONS: Stratification of baseline atherothrombotic risk can assist with therapeutic decision making for vorapaxar use for secondary prevention after MI. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00526474."}