R3 JUNG Myounghwa/Prof.KIM Woo-Shik N Engl J Med 2012;366:

PLATELET

ANTIPLATE AGENT

PARs(protease –activated receptor) potent agonist with thombin for thrombosis Vorapaxar competitive antagonist of PAR-1 Aim Atherothrombotic Ischemic Events Thrombolysis in Myocardial Infarction 50(TRA20-TIMI50 trial) evalution efficacy and safty of Vorapaxar in reducing throboembolic event

- Multicenter,double-blind,placebo-controlled trial - Sponsered by Merck center in 32 conturies INCLUSION CRITERIA MI,Stroke (2Wks ~ 12months) PPh. ARTERY DIS. (Claudication or ABI<0.85) EXCLUSION CRITERIA Planning to ungergo a revasculization procedure History of bleeding diarthesis Recent active bleeding Ongoing treatment with warfarin Active hepatobiliary disease

enrolled, median follow up period : 30months -Vorapaxar 2.5mg daily : Placebo = 1:1 -Stopped if the patient required treatment with either inhibitor of CYP3A4 enzyme system or warfarin. Primary END POINT Composite of cardiovascular death,myocardial infarction stroke, or recurrent ischemia leading to urgent coronary revascularization Moderate or severe bleeding Secondary END POINT Composite of cardiovascular death,myocardial infarction stroke

Vorapaxar reduced the risk of cardiovascular death, myocardial infarction, or stroke among patients with stable atherosclerosis BUT, Vorapaxar also increased the risk of moderate or severe bleeding, including intracranial hemorrhage, most frequently in patients with a history of stroke