A comparison of the VASP index between patients with hemodynamically complicated and uncomplicated acute myocardial infarction

Osmančík, Pavel; Jirmář, Radovan; Hulíková, Katarína; Peroutka, Zdenek; Pompachova, Alexandra; Motovska, Zuzana; Widimský, Petr

doi:10.1002/ccd.22248

Cited by 55 publications

(43 citation statements)

References 27 publications

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“…A number of recent studies also indicate that, contrary to the widely accepted theory about hypocoagulation during hypothermia, platelet activation may increase under conditions of MTH, which may also contribute to the reduced inhibitory effects of antiplatelet drugs [18][19][20]. Another very important factor that may apply to this subgroup of patients is reduced ejection fraction and hemodynamic instability or cardiogenic shock [13,21]. In our study, we did not find any other factors in the clopidogrel group that would unambiguously reduce its efficacy.…”

Section: Discussioncontrasting

confidence: 79%

“…Several small studies have described the efficacy of clopidogrel in resuscitated patients. They agree on reduced clopidogrel efficacy, but none of them evaluated the inhibitory effect continuously for the first 3 days, which would have made it possible to assess the development of platelet inhibition [4,13,14]. The largest study of the efficacy of clopidogrel compared to the new drugs prasugrel (25 patients) and ticagrelor (10 patients) in patients after OHCA treated by TH is a recent study by Ibrahim et al [5].…”

Section: Discussionmentioning

confidence: 95%

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Antiplatelet efficacy of P2Y12 inhibitors (prasugrel, ticagrelor, clopidogrel) in patients treated with mild therapeutic hypothermia after cardiac arrest due to acute myocardial infarction

Bednář

Kroupa

Ondrakova

et al. 2015

J Thromb Thrombolysis

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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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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 95%

Antiplatelet efficacy of P2Y12 inhibitors (prasugrel, ticagrelor, clopidogrel) in patients treated with mild therapeutic hypothermia after cardiac arrest due to acute myocardial infarction

Bednář

Kroupa

Ondrakova

et al. 2015

J Thromb Thrombolysis

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“…Because hemodynamic instability and/or intubation have been associated with impaired platelet inhibition after clopidogrel LD, is important to note that the present results apply to patients who are hemodynamically stable. 37 The present sample size did not provide sufficient power to allow detection of other important relationships between HTPR status and variables of interest, such as the presence of diabetes mellitus.…”

Section: Discussionmentioning

confidence: 78%

Predictors of High On-Treatment Platelet Reactivity Early After Clopidogrel Loading in ST-Elevation Myocardial Infarction

Alexopoulos¹,

Xanthopoulou²,

Tsigkas³

et al. 2012

Circ J

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“…Taken together, both also highlight the clinical efficacy of 600 mg of clopidogrel, which proved to be a high hurdle for cangrelor to overcome. In spite of the inability of cangrelor to demonstrate superiority in these trials, its noninferiority compared with 600 mg of periprocedural clopidogrel could enable it to fill a conspicuous gap in clinical practice, specifically, facilitating potent periprocedural platelet inhibition in patients unable to tolerate or properly absorb oral medications, of particular concern in patients with cardiogenic shock or those who are vomiting or who are heavily sedated (69). These observations as well as promising post hoc exploratory analyses of the CHAMPION trials might merit further study of cangrelor (70).…”

Section: The Road Ahead For Periprocedural Antiplatelet Therapymentioning

confidence: 94%

The State of Periprocedural Antiplatelet Therapy After Recent Trials

Desai

Bhatt

2010

JACC: Cardiovascular Interventions

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The ability to mechanically dilate and treat stenoses in the coronary arteries opened a new chapter in cardiovascular medicine. Percutaneous coronary intervention (PCI) has been shown to improve outcomes among patients with acute coronary syndromes as well as improve symptoms among patients with stable coronary artery disease. Adjunctive antiplatelet therapy plays a critical role both in the periprocedural setting as well as in the long-term management of atherothrombosis. Over the past several years, clinical trials of novel compounds and treatment strategies have further refined our pharmacotherapeutic approach. Aspirin remains the cornerstone for antiplatelet therapy across the spectrum of ischemic heart disease. In contrast, studies of glycoprotein IIb/IIIa inhibitors suggest a more limited role, particularly when used in addition to contemporary dual antiplatelet therapy. Clopidogrel, the most widely used P2Y(12) adenosine diphosphate receptor blocker--although having demonstrated efficacy in patients with ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndrome, and stable coronary artery disease undergoing PCI--has several limitations, including delay in onset, variability in response, and modest potency. The third-generation thienopyridine, prasugrel, as well as nonthienopyridine inhibitors of the P2Y(12) receptor such as ticagrelor and cangrelor address these shortcomings, offering more potent, consistent, and rapid platelet inhibition. Prasugrel and ticagrelor led to significant reductions in adverse cardiovascular events, including cardiovascular mortality for the latter, whereas cangrelor met noninferiority compared with 600 mg of clopidogrel in patients with ACS undergoing PCI. There are myriad novel compounds at varying stages of development, including thrombin receptor antagonists whose role in the periprocedural and long-term setting will be defined through further study. Significant questions regarding antiplatelet therapy remain unanswered, including the role of genetic and platelet function testing to "tailor therapy"; the optimal duration of therapy; and the optimal mechanism to deliver high-quality, cost-effective antiplatelet therapy to all patients.

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A comparison of the VASP index between patients with hemodynamically complicated and uncomplicated acute myocardial infarction

Abstract: Laboratory clopidogrel efficacy is lower in patients with MI and severe hemodynamic instability, probably due to splanchnic and liver hypoperfusion and catecholamine use.

Cited by 55 publications

References 27 publications

Antiplatelet efficacy of P2Y12 inhibitors (prasugrel, ticagrelor, clopidogrel) in patients treated with mild therapeutic hypothermia after cardiac arrest due to acute myocardial infarction

Antiplatelet efficacy of P2Y12 inhibitors (prasugrel, ticagrelor, clopidogrel) in patients treated with mild therapeutic hypothermia after cardiac arrest due to acute myocardial infarction

Predictors of High On-Treatment Platelet Reactivity Early After Clopidogrel Loading in ST-Elevation Myocardial Infarction

The State of Periprocedural Antiplatelet Therapy After Recent Trials

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