Author + information
- Abhishek Sharma1,
- Carl J. Lavie2,
- Gérard Helft3,
- Saurav Chatterjee4,
- Sunny Goel5,
- Aakash Garg6,
- Debabrata Mukherjee7 and
- Jonathan D. Marmur1
- 1State University of New York, Downstate Medical Center, Brooklyn, NY
- 2John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, New Orleans, LA
- 3Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, Paris, France
- 4St. Luke's-Roosevelt Hospital Center of the Mount Sinai Health System, New York, NY
- 5Maimonides Medical Center, Brooklyn, NY
- 6James J. Peters VA Medical Center, Mount Sinai School of Medicine, New York, NY
- 7Texas Tech University, El Paso, El Paso, TX
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 (PCI) or coronary artery bypass graft surgery (CABG).
We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), 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 PCI or CABG. Event rates were compared using a Forest plot of relative risk using a random effects model.
The five 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) [RR 0.83 (0.75-0.92)] and ischemic stroke [0.011 (0.007-0.016)]; however, it also resulted in significant increase risk of hemorrhagic stroke [1.57 (1.01-2.44)] and Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeds [1.36 (1.07-1.70)]. There was no significant difference in the risk of cardiovascular mortality [0.90 (0.73-1.09)], repeat revascularization [0.78 (0.23-2.70)] and stent thrombosis [0.95 (0.62-1.45)] in the vorapaxar and control groups.
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 TIMI major and minor bleeds.