Vorapaxar: Are Small Secondary-Prevention Gains Worth the Bleeding Risk?

As Bloomberg reported in January, “Vorapaxar was touted by [Merck] as its most promising experimental drug from the $49 billion purchase of Schering-Plough in November 2009.” In the TRACER trial, which was halted early, vorapaxar markedly increased bleeding in high-risk patients with non–ST-segment-elevation myocardial infarction (MI), most of whom were already receiving dual antiplatelet therapy (JW Cardiol Nov 13 2011).

Results are now reported from another manufacturer-funded vorapaxar trial, TRA 2P–TIMI 50. Investigators randomized 26,449 patients (median age, 61) with prior MI, ischemic stroke, or peripheral artery disease to receive vorapaxar (2.5 mg/day) or placebo. All participants were taking aspirin; many were on a second antiplate…