Background: Vorapaxar is a PAR-1 antagonist that is approved for secondary prevention of cardiovascular events but has been associated with increased intracranial hemorrhage. Methods: The TRACER trial compared vorapaxar vs. placebo among patients with ACS. Strokes were adjudicated by a central events committee. Stroke severity was assessed by sites using the modified Rankin score. Results: Of 12,944 patients, 199 (1.5%) had ≥1 stroke during the study period (median follow-up 477 days). Four patients had a single stroke of unknown type; 195 had ≥1 stroke (165 non-hemorrhagic, 28 hemorrhagic, and 2 both). Strokes occurred in 96/6473 (1.5%) patients assigned vorapaxar and 103/6471 (1.6%) patients assigned placebo. Vorapaxar-assigned patients had a higher proportion of hemorrhagic strokes (22/96 [22.9%] vs. 8/103 [7.8%]) and a lower proportion of non-hemorrhagic stroke (74/96 [77.1%] vs. 93/103 [90.3%]). Kaplan-Meier incidence of stroke for vorapaxar vs. placebo was higher for hemorrhagic stroke, lower but not significantly different for non-hemorrhagic stroke, and similar for stroke overall (Figure 1). Rankin scores at discharge were reported in 59/96 strokes with vorapaxar and 64/103 strokes with placebo. More than half of patients in each group reported less than moderate disability (Rankin 0-2; 59% [35/59] vorapaxar vs. 55% [35/64] placebo); moderate to severe disability (Rankin 3-5) was reported in 29% (17/59) and 31% (20/64); and death (Rankin 6) was reported in 11.9% (7/59) and 14.1% (9/64). Conclusion: Stroke occurred in <2% of patients. Vorapaxar-assigned patients had increased hemorrhagic stroke but a non-significant trend toward lower non-hemorrhagic stroke. Overall stroke frequency and severity were similar with vorapaxar vs. placebo. [ABSTRACT FROM AUTHOR]