Antiplatelet efficacy of P2Y12 inhibitors (prasugrel, ticagrelor, clopidogrel) in patients treated with mild therapeutic hypothermia after cardiac arrest due to acute myocardial infarction
Language English Country Netherlands Media print
Document type Clinical Trial, Comparative Study, Journal Article, Observational Study, Research Support, Non-U.S. Gov't
PubMed
26340851
DOI
10.1007/s11239-015-1274-7
PII: 10.1007/s11239-015-1274-7
Knihovny.cz E-resources
- Keywords
- Cardiac arrest, Clopidogrel, Hypothermia, Myocardial infarction, Prasugrel, Ticagrelor,
- MeSH
- Adenosine administration & dosage analogs & derivatives MeSH
- Myocardial Infarction complications therapy MeSH
- Clopidogrel MeSH
- Middle Aged MeSH
- Humans MeSH
- Prasugrel Hydrochloride administration & dosage MeSH
- Prospective Studies MeSH
- Purinergic P2Y Receptor Agonists administration & dosage MeSH
- Aged MeSH
- Heart Arrest etiology therapy MeSH
- Hypothermia, Induced methods MeSH
- Ticagrelor MeSH
- Ticlopidine administration & dosage analogs & derivatives MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Comparative Study MeSH
- Names of Substances
- Adenosine MeSH
- Clopidogrel MeSH
- Prasugrel Hydrochloride MeSH
- Purinergic P2Y Receptor Agonists MeSH
- Ticagrelor MeSH
- Ticlopidine MeSH
Survivors after cardiac arrest (CA) due to AMI undergo PCI and then receive dual antiplatelet therapy. Mild therapeutic hypothermia (MTH) is recommended for unconscious patients after CA to improve neurological outcomes. MTH can attenuate the effectiveness of P2Y12 inhibitors by reducing gastrointestinal absorption and metabolic activation. The combined effect of these conditions on the efficacy of P2Y12 inhibitors is unknown. We compared the antiplatelet efficacies of new P2Y12 inhibitors in AMI patients after CA treated with MTH. Forty patients after CA for AMI treated with MTH and received one P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) were enrolled in a prospective observational single-center study. Platelet inhibition was measured by VASP (PRI) on days 1, 2, and 3 after drug administration. In-hospital clinical data and 1-year survival data were obtained. The proportion of patients with ineffective platelet inhibition (PRI > 50 %, high on-treatment platelet reactivity) for clopidogrel, prasugrel, and ticagrelor was 77 vs. 19 vs. 1 % on day 1; 77 vs. 17 vs. 0 % on day 2; and 85 vs. 6 vs. 0 % on day 3 (P < 0.001). The platelet inhibition was significantly worse in clopidogrel group than in prasugrel or ticagrelor group. Prasugrel and ticagrelor are very effective for platelet inhibition in patients treated with MTH after CA due to AMI, but clopidogrel is not. Using prasugrel or ticagrelor seems to be a more suitable option in this high-risk group of acute patients.
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