We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Viewpoint |

Secondary Prevention of Cardiovascular Disease With Vorapaxar A New Era of 3-Drug Antiplatelet Therapy?

Mori J. Krantz, MD1,2,3; Sanjay Kaul, MD4,5
[+] Author Affiliations
1Division of Cardiology, University of Colorado School of Medicine, Aurora
2Denver Health Medical Center, Denver, Colorado
3Colorado Prevention Center, Aurora
4Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
5David Geffen School of Medicine at the University of California, Los Angeles
JAMA Intern Med. 2015;175(1):9-10. doi:10.1001/jamainternmed.2014.5802.
Text Size: A A A
Published online


This Viewpoint questions the benefit-risk balance of vorapaxar use as a component of 3-drug antiplatelet therapy for cardiovascular disease.

In May 2014, the US Food and Drug Administration (FDA) approved vorapaxar (Zontivity; Merck), an oral antiplatelet agent, for the reduction of thrombotic cardiovascular events in patients with a history of myocardial infarction or peripheral arterial disease.1 The FDA acted after a 10 to 1 vote in favor of approval in January 2014 by the Cardiovascular and Renal Drugs Advisory Committee; both of us were members of this committee, and one of us (M.J.K.) cast the negative vote. Physicians should understand the benefit-risk balance of vorapaxar: the important benefit is the drug’s potential role in clinical practice as part of a 3-drug antiplatelet regimen for secondary prevention of myocardial infarction and in peripheral artery disease; the serious risk is clinically significant bleeding, including intracranial hemorrhage.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

3 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Matching Content and Context: Evidence-Based Teaching Scripts

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Verbal Synopses