WARNING: BLEEDING RISK
Do not use ZONTIVITY in patients with a history of stroke, transient ischemic attack (TIA), or intracranial hemorrhage (ICH); or active pathological bleeding [see CONTRAINDICATIONS (4.1, 4.2) ].
Antiplatelet agents, including ZONTIVITY, increase the risk of bleeding, including ICH and fatal bleeding [see Warnings and Precautions].
ZONTIVITY contains vorapaxar sulfate, a tricyclic himbacine-derived selective inhibitor of platelet aggregation mediated by PAR-1.
Patients with History of Myocardial Infarction (MI) or with Peripheral Arterial Disease (PAD)
ZONTIVITY is indicated for the reduction of thrombotic cardiovascular events in patients with a history of myocardial infarction (MI) or with peripheral arterial disease (PAD). ZONTIVITY has been shown to reduce the rate of a combined endpoint of cardiovascular death, MI, stroke, and urgent coronary revascularization (UCR).
Published Studies Related to Zontivity (Vorapaxar)
New ischemic stroke and outcomes with vorapaxar versus placebo: results from the
TRA 2 °P-TIMI 50 trial. 
MI or PAD and no cerebrovascular disease (CVD) treated with vorapaxar... CONCLUSIONS: Vorapaxar reduces ischemic stroke in patients with MI or PAD and no
Vorapaxar in patients with peripheral artery disease and acute coronary syndrome:
insights from Thrombin Receptor Antagonist for Clinical Event Reduction in Acute
Coronary Syndrome (TRACER). 
ACS patients with documented PAD... CONCLUSIONS: Patients with NSTE ACS and PAD were at increased risk for ischemic
Usefulness and safety of vorapaxar in patients with non-ST-segment elevation
acute coronary syndrome undergoing percutaneous coronary intervention (from the
TRACER Trial). 
The therapeutic potential of vorapaxar in patients with non-ST-segment elevation
acute coronary syndrome undergoing percutaneous coronary intervention (PCI) is
unknown. This prespecified analysis of a postrandomization subgroup evaluated the
effects of vorapaxar compared with placebo among Thrombin Receptor Antagonist for
Clinical Event Reduction in Acute Coronary Syndrome (TRACER) participants
undergoing PCI, focusing on the implanted stent type (drug-eluting stent [DES] vs
bare-metal stent [BMS])...
Vorapaxar, a platelet thrombin-receptor antagonist, in medically managed patients
with non-ST-segment elevation acute coronary syndrome: results from the TRACER
prognosis and outcomes of vorapaxar vs. placebo... CONCLUSIONS: NSTEACS patients who were initially medically managed had a higher
Association of aspirin dose and vorapaxar safety and efficacy in patients with
non-ST-segment elevation acute coronary syndrome (from the TRACER Trial). 
Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary
Syndrome (TRACER) trial compared vorapaxar and placebo in 12,944 high-risk
patients with non-ST-segment elevation acute coronary syndrome. We explored
aspirin (ASA) use and its association with outcomes... Although formal statistical testing did not reveal heterogeneity in vorapaxar's
effect across dose subgroups, consistent trends support use of low-dose ASA with
other antiplatelet therapies.
Clinical Trials Related to Zontivity (Vorapaxar)
Vorapaxar Study for Maturation of AV Fistulae for Hemodialysis Access [Not yet recruiting]
The Objectives of this study are:
1. To determine if vorapaxar safely improves arteriovenous (AV) fistula functional
maturation when administered during the maturation process compared with placebo.
2. To determine if vorapaxar safely improves AV fistula patency, allowing for secondary
procedures to aid in fistula maturation compared with placebo.
3. To determine if vorapaxar safely facilitates successful cannulation of AV fistulas for
hemodialysis compared with placebo.
This is a randomized placebo-controlled double-blind pilot trial. Study procedures will be
conducted at Stanford University Medical Center, and standard-of-care (SOC) procedures will
be conducted at Stanford and it's affiliated hospitals (Veteran's Affairs Palo Alto Health
Care System and the Stanford Vascular Surgery Clinic at Valley Medical Center). The
investigators expect to enroll 128 patients. Patients will be assigned to treatment groups
with a 1: 1 randomization in blocks of 4 at the conclusion of the AV fistula creation.
Patients will be stratified based on fistula location (lower arm versus upper arm).
Attenuation of D-dimer Using Vorapaxar to Target Inflammatory and Coagulation Endpoints [Not yet recruiting]
ADVICE is a randomised, international, double-blind, placebo-controlled trial. The purpose
of the ADVICE study is to compare the safety and efficacy of vorapaxar in reducing d-dimer
expression and markers of cellular immune activation over a period of 12 weeks among people
with HIV infection who are successfully treated with combination antiretroviral therapy
containing an HIV integrase inhibitor. A secondary objective of the study will be to
demonstrate that following cessation of vorapaxar in patients with well controlled HIV
replication there will be an increase in the levels of d-dimer over a 6 week period. 60
participants from 4 clinical sites in Australia and the USA will be recruited and followed
for a minimum of 18 weeks.
Page last updated: 2015-08-10