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PAR-1 (Protease-Activated Receptor-1) Antagonist — Secondary Prevention in PAD / MI

Vorapaxar

Brand names: Zontivity

Vorapaxar is an oral antiplatelet agent used, in addition to standard antiplatelet therapy, to reduce atherothrombotic events in patients with a history of myocardial infarction or peripheral arterial disease.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It is a protease-activated receptor-1 (PAR-1) antagonist that inhibits thrombin-mediated platelet activation and aggregation.

Prescribing in practice

  • It increases the risk of bleeding, including intracranial haemorrhage, and is contraindicated in patients with a history of stroke, transient ischaemic attack or intracranial bleeding.
  • It is used as an addition to aspirin and/or a thienopyridine, and combined antiplatelet therapy further raises bleeding risk.
  • Its long-lasting platelet effect means antiplatelet activity persists for a prolonged period after discontinuation.

Monitoring

Monitor for signs and symptoms of bleeding, with particular vigilance for neurological features suggesting intracranial haemorrhage.

Counselling the patient

  • Report any unusual or prolonged bleeding, bruising, or signs of stroke such as sudden weakness or severe headache promptly.
  • Do not stop the medicine without advice, as this can increase cardiovascular risk.
  • Tell other clinicians and dentists that you take an antiplatelet medicine before any procedure.

Evidence & guidelines

The TRA 2P-TIMI 50 trial demonstrated a reduction in atherothrombotic events with vorapaxar at the cost of increased bleeding, informing its restricted use.

Reference: TRA 2P-TIMI 50 Trial 2012; MHRA Vorapaxar SPC; ESC/ESVS PAD Guidelines 2017; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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