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Vorapaxar, a platelet thrombin-receptor inhibitor, is the latest among many new contestants in the campaign to reduce ischemic events after acute coronary syndromes (ACS) without increasing major bleeding — an elusive achievement so far. In the manufacturer-sponsored TRACER trial, investigators enrolled 12,944 patients (mean age, 64 17% aged ≥75; 28% women) with ACS symptoms within 24 hours before hospital presentation without persistent ST-segment elevation. Patients were randomized to receive placebo or vorapaxar (loading dose, 40 mg; 2.5 mg daily thereafter) in addition to standard therapy including aspirin and a thienopyridine.
Follow-up was stopped early because of safety concerns. At a median of 502 days, the rate of the composite prim…