Jean-François Llitjos1, Georgios Sideris1, Sebastian Voicu2, Claire Bal Dit Sollier3, Nicolas Deye2, Bruno Megarbane2, Ludovic Drouet3, Patrick Henry1, Jean-Guillaume Dillinger4. 1. Department of Cardiology - Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Sorbonne Paris Cité, Paris, France. 2. Department of Medical and Toxicological Critical Care, Inserm U1144, Lariboisiere Hospital, AP-HP, Paris Diderot University, Sorbonne Paris Cité, Paris, France. 3. Thrombosis and Atherosclerosis Research Unit, Vessels and Blood Institute (IVS), Anticoagulation Clinic (CREATIF), Lariboisiere Hospital, and Paris VII University EA 7334 REMES, Paris, France. 4. Department of Cardiology - Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Sorbonne Paris Cité, Paris, France; Thrombosis and Atherosclerosis Research Unit, Vessels and Blood Institute (IVS), Anticoagulation Clinic (CREATIF), Lariboisiere Hospital, and Paris VII University EA 7334 REMES, Paris, France. Electronic address: jean-guillaume.dillinger@aphp.fr.
Abstract
AIM OF THE STUDY: Acute coronary syndrome is one of the main causes of out-of-hospital cardiac arrest (OHCA). OHCA patients are particularly exposed to high platelet reactivity (HPR) under aspirin (ASA) treatment. The aim was to evaluate HPR-ASA in therapeutic hypothermia comatose patients resuscitated from OHCA. METHODS AND RESULTS:Twenty-two consecutive patients with OHCA of cardiac origin were prospectively included after therapeutic hypothermia and randomized to receive ASA 100mg per day, either intravenously (n=13) or orally via a gastric tube (n=9). ADP inhibitors (prasugrel or, if contra-indicated, clopidogrel) were administered in the event of angioplasty. HPR-ASA was assessed by light transmission aggregometry (LTA) with arachidonic acid (AA) and by the PFA-100(®) system with collagen/epinephrine. Clinical, biological and angiographic characteristics were similar in both groups. Using LTA-AA, maximum aggregation intensity was significantly lower in the intravenous group compared to the oral group (15% vs. 29%, respectively; p=0.04). Overall, 10 patients (45%) had HPR-ASA (38% intravenously vs 56% orally; p=0.7). Similarly, closure time was significantly increased in the IV group (277s vs. 155s, respectively; p=0.04). CONCLUSION: This study suggests that impaired response to both intravenous and oral aspirin is frequent in comatose patients resuscitated from OHCA.
RCT Entities:
AIM OF THE STUDY: Acute coronary syndrome is one of the main causes of out-of-hospital cardiac arrest (OHCA). OHCA patients are particularly exposed to high platelet reactivity (HPR) under aspirin (ASA) treatment. The aim was to evaluate HPR-ASA in therapeutic hypothermia comatosepatients resuscitated from OHCA. METHODS AND RESULTS: Twenty-two consecutive patients with OHCA of cardiac origin were prospectively included after therapeutic hypothermia and randomized to receive ASA 100mg per day, either intravenously (n=13) or orally via a gastric tube (n=9). ADP inhibitors (prasugrel or, if contra-indicated, clopidogrel) were administered in the event of angioplasty. HPR-ASA was assessed by light transmission aggregometry (LTA) with arachidonic acid (AA) and by the PFA-100(®) system with collagen/epinephrine. Clinical, biological and angiographic characteristics were similar in both groups. Using LTA-AA, maximum aggregation intensity was significantly lower in the intravenous group compared to the oral group (15% vs. 29%, respectively; p=0.04). Overall, 10 patients (45%) had HPR-ASA (38% intravenously vs 56% orally; p=0.7). Similarly, closure time was significantly increased in the IV group (277s vs. 155s, respectively; p=0.04). CONCLUSION: This study suggests that impaired response to both intravenous and oral aspirin is frequent in comatosepatients resuscitated from OHCA.
Authors: Florian Prüller; Oliver Leopold Milke; Lukasz Bis; Friedrich Fruhwald; Daniel Scherr; Philipp Eller; Sascha Pätzold; Siegfried Altmanninger-Sock; Peter Rainer; Jolanta Siller-Matula; Dirk von Lewinski Journal: Ann Intensive Care Date: 2018-02-21 Impact factor: 6.925
Authors: Razvan I Radu; Tuvia Ben Gal; Magdy Abdelhamid; Elena-Laura Antohi; Marianna Adamo; Andrew P Ambrosy; Oliviana Geavlete; Yuri Lopatin; Alexander Lyon; Oscar Miro; Marco Metra; John Parissis; Sean P Collins; Stefan D Anker; Ovidiu Chioncel Journal: ESC Heart Fail Date: 2021-10-19