Marek T Tomala1,2, Aleksander Trąbka-Zawicki3,4, Andrzej Machnik3,4, Bartłomiej A Nawrotek3,4, Wojciech Zajdel3,4, Ewa Ł Stępień5, Jacek Legutko3,4, Krzysztof Żmudka3,4. 1. Jagiellonian University Medical College Institute of Cardiology, Department of Interventional Cardiology, Krakow, Poland. marektomala@gmail.com. 2. Krakow Specialist Hospital named after John Paul II, Clinical Department of Interventional Cardiology, Krakow, Poland. marektomala@gmail.com. 3. Jagiellonian University Medical College Institute of Cardiology, Department of Interventional Cardiology, Krakow, Poland. 4. Krakow Specialist Hospital named after John Paul II, Clinical Department of Interventional Cardiology, Krakow, Poland. 5. Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Krakow, Poland.
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 (ST). 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.
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 (ST). 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 infarctionpatients after OHCA treated with primary PCI undergoing hypothermia. The use of cooling was not associated with an increased risk of stent thrombosis.
Authors: Jacek Kubica; Piotr Adamski; Jerzy R Ładny; Jarosław Kaźmierczak; Tomasz Fabiszak; Krzysztof J Filipiak; Robert Gajda; Mariusz Gąsior; Zbigniew Gąsior; Robert Gil; Jarosław Gorący; Stefan Grajek; Leszek Gromadziński; Marcin Gruchała; Grzegorz Grześk; Piotr Hoffman; Miłosz J Jaguszewski; Marianna Janion; Piotr Jankowski; Zbigniew Kalarus; Jarosław D Kasprzak; Andrzej Kleinrok; Wacław Kochman; Aldona Kubica; Wiktor Kuliczkowski; Jacek Legutko; Maciej Lesiak; Klaudiusz Nadolny; Eliano P Navarese; Piotr Niezgoda; Małgorzata Ostrowska; Przemysław Paciorek; Jolanta Siller-Matula; Łukasz Szarpak; Dariusz Timler; Adam Witkowski; Wojciech Wojakowski; Andrzej Wysokiński; Marzenna Zielińska Journal: Cardiol J Date: 2022-05-06 Impact factor: 3.487