Association of antiplatelet therapy with patient outcomes after out-of-hospital cardiac arrest

Abstract

Background Cessation of blood flow during out-of-hospital cardiac arrest (OHCA) results in microvascular thrombosis, protracted hypoperfusion after return of spontaneous circulation and damage to vital organs. We tested the hypothesis that pre-arrest antiplatelet and anticoagulant medication use would be associated with less post-arrest organ dysfunction and better outcomes. Methods We included OHCA patients treated from January 2005 to October 2014 at a single academic medical center. We combined our prospective OHCA registry of clinical and demographic data with a structured chart review to abstract home antiplatelet and anticoagulant medications. We fit unadjusted and adjusted regression models to test the association of antiplatelet and anticoagulant medication use with early post-arrest illness severity, survival and functionally favorable recovery. Results Of 1054 subjects, 295 (28%) were prescribed an antiplatelet agent and 147 (14%) were prescribed an anticoagulant prior to arrest. In adjusted models, antiplatelet agents were associated with lower post-arrest illness severity (adjusted OR 0.50 95% CI 0.33-0.77), greater odds of survival to discharge (adjusted OR 1.74 95% CI 1.08-2.80) and greater odds favorable functional outcome (adjusted OR 2.11 95% CI 1.17-3.79). By contrast, anticoagulation via any agent was not associated with illness severity, survival to discharge or favorable outcome. Conclusion Preventing intra-arrest and post-arrest microvascular thrombosis via antiplatelet agents could represent a novel therapeutic target to improve outcomes after OHCA.

European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care

“…275 Post-cardiac arrest patients are likely to be at higher risk than general ICU patients given the use of anticoagulant and antiplatelet agents both pre and post arrest. 276 Therefore, it appears reasonable to administer stress ulcer prophylaxis in post-cardiac arrest patients, especially in those with coagulopathy. 35 Unless patients receive anticoagulation because of a myocardial infarction or ischaemia, deep venous thrombosis prophylaxis is recommended in critically ill patients.…”

European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care

“…However, a recent meta-analysis showed that in high-risk patients, the use of ulcer prophylaxis decreased gastrointestinal bleeding [275]. Post-cardiac arrest patients are likely to be at higher risk than general ICU patients given the use of anticoagulant and antiplatelet agents both pre and post arrest [276]. Therefore, it appears reasonable to administer stress ulcer prophylaxis in post-cardiac arrest patients, especially in those with coagulopathy [35].…”

Anticoagulation therapy could improve the restoration of sinus rhythm and spontaneous circulation in hospital patients with CPR

“…5 A study in patients treated with out-of-hospital CPR found that antiplatelet therapy reduced post-arrest illness severity (adjusted OR 0.50, 95% CI 0.33, 0.77) and was associated with higher survival rates (adjusted OR 1.74, 95% CI 1.08, 2.80) and greater odds of a favourable functional outcome (adjusted OR 2.11 95% CI 1.17, 3.79), but anticoagulation therapy was not associated with illness severity, survival to discharge or favourable outcomes. 6 The possible reasons for these findings being different to those of the current study are as follows: (i) the restoration of sinus rhythm and spontaneous circulation are two of the most important signs of the success of CPR, but this previous study didn’t include these parameters; 6 (ii) the two clinical studies had different study populations, with the cases included in the previous study being patients with out-of-hospital cardiac arrest, 6 but the patients in the current study experienced in-hospital cardiac arrest. The survival to discharge and favourable outcomes were consistent with this current study, which suggest that the conclusion is reliable.…”

“…5 Another study found that anticoagulation therapy was not associated with the outcome in patients with out-ofhospital CPR. 6 There have not been any studies undertaken to study the relationship between anticoagulation therapy and the prognosis of patients treated with CPR in hospital. This study hypothesized that anticoagulation therapy might improve the outcome of patients undergoing CPR.…”

“…5 Another study found that anticoagulation therapy was not associated with the outcome in patients with out-of-hospital CPR. 6…”