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Ticagrelor effectively inhibits platelet aggregation in comatose survivors of cardiac arrest undergoing primary percutaneous coronary intervention treated with mild therapeutic hypothermia
, 12, 12, 12, 12, 3, 12, 12
Affiliations- Jagiellonian University Medical College Institute of Cardiology, Department of Interventional Cardiology, Krakow, Poland
- Krakow Specialist Hospital named after John Paul II, Clinical Department of Interventional Cardiology, Krakow, Poland
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Krakow, Poland
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Abstract
Background: Mild therapeutic hypothermia (MTH) is believed to reduce the effectiveness of antiplatelet
drugs. Effective dual-antiplatelet therapy after percutaneous coronary intervention (PCI) is mandatory
to avoid acute stent thrombosis. The effectiveness of ticagrelor in MTH-treated out-of-hospital cardiac
arrest (OHCA) survivors is still a matter of debate. The aim of the study was to evaluate the impact
of MTH on the platelet-inhibitory effect of ticagrelor in comatose survivors of OHCA treated with primary
PCI.
Methods: Eighteen comatose survivors of OHCA with acute coronary syndrome undergoing immediate
PCI treated with MTH were compared with 14 patients with uncomplicated primary myocardial infarction
after PCI, matched for gender and age, in a prospective, single-center, observational study. Platelet
aggregation was evaluated using VerifyNow P2Y12 point-of-care testing at 3 time points: admission (T0),
during MTH (T1), and 48–72 h after rewarming (T2).
Results: Ticagrelor effectively inhibits platelet aggregation in OHCA patients subjected to MTH and
in all patients in the control group. The effectiveness of ticagrelor did not differ between the MTH group
and the control group (p = 0.581). In 2 cases in the MTH population, the platelet response to ticagrelor
was inadequate, and in one of them it remained insufficient during the re-warming phase. There was
no stent thrombosis in these patients.
Conclusions: The present study confirmed the effectiveness of ticagrelor to inhibit platelets in myocardial
infarction patients after OHCA treated with primary PCI undergoing hypothermia. The use of
cooling was not associated with an increased risk of stent thrombosis.
Abstract
Background: Mild therapeutic hypothermia (MTH) is believed to reduce the effectiveness of antiplatelet
drugs. Effective dual-antiplatelet therapy after percutaneous coronary intervention (PCI) is mandatory
to avoid acute stent thrombosis. The effectiveness of ticagrelor in MTH-treated out-of-hospital cardiac
arrest (OHCA) survivors is still a matter of debate. The aim of the study was to evaluate the impact
of MTH on the platelet-inhibitory effect of ticagrelor in comatose survivors of OHCA treated with primary
PCI.
Methods: Eighteen comatose survivors of OHCA with acute coronary syndrome undergoing immediate
PCI treated with MTH were compared with 14 patients with uncomplicated primary myocardial infarction
after PCI, matched for gender and age, in a prospective, single-center, observational study. Platelet
aggregation was evaluated using VerifyNow P2Y12 point-of-care testing at 3 time points: admission (T0),
during MTH (T1), and 48–72 h after rewarming (T2).
Results: Ticagrelor effectively inhibits platelet aggregation in OHCA patients subjected to MTH and
in all patients in the control group. The effectiveness of ticagrelor did not differ between the MTH group
and the control group (p = 0.581). In 2 cases in the MTH population, the platelet response to ticagrelor
was inadequate, and in one of them it remained insufficient during the re-warming phase. There was
no stent thrombosis in these patients.
Conclusions: The present study confirmed the effectiveness of ticagrelor to inhibit platelets in myocardial
infarction patients after OHCA treated with primary PCI undergoing hypothermia. The use of
cooling was not associated with an increased risk of stent thrombosis.
Keywords
out-of-hospital cardiac arrest, platelet function, primary percutaneous coronary intervention, ticagrelor, VerifyNow
About this articleTitle
Ticagrelor effectively inhibits platelet aggregation in comatose survivors of cardiac arrest undergoing primary percutaneous coronary intervention treated with mild therapeutic hypothermia
Journal
Issue
Article type
Original Article
Pages
636-645
Published online
2021-06-16
Page views
2279
Article views/downloads
773
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(4):636-645.
Keywords
out-of-hospital cardiac arrest
platelet function
primary percutaneous coronary intervention
ticagrelor
VerifyNow
Authors
Marek T. Tomala
Aleksander Trąbka-Zawicki
Andrzej Machnik
Bartłomiej A. Nawrotek
Wojciech Zajdel
Ewa Ł. Stępień
Jacek Legutko
Krzysztof Żmudka
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