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.
- MeSH
- adenosin aplikace a dávkování analogy a deriváty MeSH
- infarkt myokardu komplikace terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prasugrel hydrochlorid aplikace a dávkování MeSH
- prospektivní studie MeSH
- purinergní receptory P2Y - agonisté aplikace a dávkování MeSH
- senioři MeSH
- srdeční zástava etiologie terapie MeSH
- terapeutická hypotermie metody MeSH
- tiklopidin aplikace a dávkování analogy a deriváty MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
OBJECTIVE: Aspirin therapy decreases mortality and ischemic complication rates after coronary artery bypass grafting (CABG). However, platelet inhibition after oral aspirin seems to be insufficient in the early postoperative period. There are incomplete data reporting aspirin efficacy early after CABG. The aim of this study was to assess the pharmacologic effect of aspirin on platelets in the first postoperative days using the most specific laboratory tests for the evaluation of aspirin efficacy. DESIGN: A prospective study. SETTING: A clinical study in one cardiac surgery center and measurements in two pharmacologic institutions. PARTICIPANTS: Thirty patients. INTERVENTIONS: Postoperative aspirin efficacy (200 mg/d) was assessed by the suppression of serum thromboxane B(2) (TxB(2)) and by arachidonic acid-induced aggregometry using the MULTIPLATE analyzer. Samples were collected before surgery and on postoperative days 1-5. METHODS AND MAIN RESULTS: The median baseline value (range) of serum TxB(2) was 1.6 ng/mL (1.4-1.9). The median TxB(2) inhibition >90% (the value required for full platelet inhibition) was not achieved until day 5 (-91%, 0.13 ng/mL [0.08-0.22], p < 0.001) and in only 55% of patients. The median baseline ASPI value was 805 (640-975) aggregation units (AU)*min. A significant decrease in aspirin insufficiency was not seen before postoperative day 5 (390 [243-621], p < 0.003) and only 34% of patients reached an effective platelet inhibition on day 5 (cutoff < 300 AU*min). CONCLUSIONS: The effect of aspirin on inhibition of TxB(2) production and arachidonic acid-induced platelet aggregation is impaired during the first postoperative days after CABG. A more effective antiplatelet strategy presumably could increase early graft patency and improve clinical outcomes after CABG.
- MeSH
- agregace trombocytů účinky léků MeSH
- Aspirin farmakologie MeSH
- inhibitory agregace trombocytů farmakologie MeSH
- koronární bypass MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- thromboxan B2 biosyntéza MeSH
- trombocyty účinky léků fyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Cíl studie: Fast-track (opiátová složka alfentanil) a ultra-fast-track (opiátová složka remifentanil) - metody vedení celkové anestezie - se na našem pracovišti standardně užívají od roku 2001. Cílem práce je porovnat výsledky obou metod. Typ studie: Prospektivní observační studie. Název a sídlo pracoviště: Kardiochirurgická klinika FN Královské Vinohrady a 3. LF UK, Praha. Materiál a metody: V prospektivní studii bylo v průběhu roku 2006 sledováno 71 pacientů (alfentanil 32, remifentanil 39) podstupujících všechny typy standardních kardiochirurgických operací. Sledovány byly tyto parametry: čas do extubace, délka pobytu na jednotce pooperační a resuscitační péče, celková délka pobytu na kardiochirurgické klinice, výskyt pooperační fibrilace síní, hodnoty krevních plynů a hodnocení pooperační bolesti (měřena 1 hodinu po extubaci, 1. pooperační den pomocí vizuální analogové stupnice bolesti a zkrácené formy McGillského dotazníku bolesti) a počet analgetických dávek. Výsledky: Mezi skupinami jsme ve většině sledovaných parametrů neshledali statisticky významné rozdíly. Vnímání pooperační bolesti bylo závislé pouze na věku (p < 0,001) a na pohlaví pacienta (p = 0,042). Závěr: Obě metody umožnily časnou a bezpečnou pooperační extubaci kardiochirurgických nemocných.
Objective: We háve been using fast-track techniques (alfentanil and remifentanil based) for cardiac anae¬sthesia in our department routinely since 2001. The aim of this study was to compare these two methods. Design: A prospective follow-up study. Setting: Department of Cardiac Surgery, University Hospital Královské Vinohrady, Charles University, Pra-gue. Materials and methods: In the prospective follow-up study, 71 consecutive patients (alfentanil 32, remifenta¬nil 39) undergoing common cardiothoracic procedures were observed during 2006.The following parameters were observed: time to extubation, length of ICU stay, length of stay on ward, incidence of postoperative atrial fibrillation, blood gases, postoperative pain grade (assessed 1 hour after extubation and on 1st post¬operative day on the visual analogue pain scale and the SF McGill questionnaire), analgesic requirements. Results:There were no statistically significant differences in the most of observed parameters. Postope¬rative pain was dependent solely on patients age (p <0.001) and gender (p =0.042). Conclusion: Both methods allow early and safe extubation of patients undergoing cardiothoracic surgery.
