Out-of-hospital cardiac arrest and stent thrombosis: Ticagrelor versus clopidogrel in patients with primary percutaneous coronary intervention under mild therapeutic hypothermia

Jiménez-Brítez, Gustavo; Freixa, Xavier; Flores‐Umanzor, Eduardo; Antonio, Rodolfo San; Caixal, Gala; Garcia, Julien; Hernández-Enrı́quez, Marco; Andrea, Rut; Regueiro, Ander; Masotti, Mónica; Brugaletta, Salvatore; Martín, Virginia; Sabaté, Manel

doi:10.1016/j.resuscitation.2017.02.015

Cited by 32 publications

(16 citation statements)

References 27 publications

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“…Our final analysis included five studies with a total of 290 patients. One study was a prospective randomized-controlled trial [ 2 ], while two studies were prospective non-randomized [ 1 , 6 ] and two studies were retrospective studies [ 3 , 4 ]. In those studies, TH protocols included maintaining a temperature of 32–34 °C for 12–24 h (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Further sub-group analysis showed no difference when comparing clopidogrel versus ticagrelor (RR 1.09; 95% CI 0.37–3.24; p = 0.88) or clopidogrel versus prasugrel (RR 0.38; 95% CI 0.09–1.51; p = 0.17) ( P interaction = 0.24). In-hospital all-cause mortality (reported in three studies) was not statistically different between clopidogrel 20 (24.4%) and newer agents 11 (15.5%) (RR 1.38; 95% CI 0.72–2.65; p = 0.34; I 2 = 0%) [ 1 , 4 , 6 ]. Similarly, three studies reported major bleeding events [ 1 , 4 , 6 ], and no significant difference was detected between clopidogrel 8 (9.8%) and newer agents 7 (9.9%) (RR 0.89; 95% CI 0.33–2.40; p = 0.82; I 2 = 0%).…”

Section: Resultsmentioning

confidence: 99%

“…The impact of TH on outcomes of PCI remains debatable. Some studies have demonstrated higher incidence of stent thrombosis associating TH after PCI [ 3 , 4 ]. Experimental studies have raised concerns regarding the efficacy of clopidogrel in cases of hypothermia, possibly by augmenting adenosine diphosphate (ADP)- induced platelet aggregation [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Clopidogrel Versus Newer P2Y12 Antagonists for Percutaneous Coronary Intervention in Patients with Out-of-Hospital Cardiac Arrest Managed with Therapeutic Hypothermia: A Meta-Analysis

et al. 2018

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IntroductionThe impact of therapeutic hypothermia (TH) on outcomes of percutaneous coronary intervention (PCI) and the optimal antiplatelet treatment remains debatable.MethodsElectronic databases were searched for randomized trials and observational studies to evaluate the available clinical evidence comparing the use of clopidogrel versus newer P2Y12 antagonists in cases of TH after PCI. The primary outcome was in-hospital definite stent thrombosis while the secondary outcomes were in-hospital mortality and major bleeding. Fixed-effects risk ratios (RRs) were estimated using Mantel–Haenszel method.ResultsThe final analysis included five studies with a total of 290 patients. There was no difference in the incidence of stent thrombosis (RR 0.92; 95% CI 0.35–2.38), in-hospital mortality (RR 1.38; 95% CI 0.72–2.65), and major bleeding (RR 0.89; 95% CI 0.33–2.40) between patients receiving clopidogrel versus those receiving newer agents.ConclusionsThis meta-analysis showed no difference between clopidogrel and newer antiplatelet agents in the incidence of stent thrombosis or in-hospital mortality for PCI in cases of TH. Further randomized studies are needed to explore the optimal dual antiplatelet treatment in TH.Electronic supplementary materialThe online version of this article (10.1007/s40119-018-0118-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clopidogrel Versus Newer P2Y12 Antagonists for Percutaneous Coronary Intervention in Patients with Out-of-Hospital Cardiac Arrest Managed with Therapeutic Hypothermia: A Meta-Analysis

et al. 2018

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“…The high rate of stent thrombosis observed in some studies in resuscitated MI patients treated with MTH and primary PCI may be caused by insufficient inhibition of P2Y 12 platelet receptors [23,24,[36][37][38][39][40]. In an observational study published by Gouffran et al [24], 10.9% of OHCA survivors treated with MTH had stent thrombosis (the latter occurred in 4.2% of patients on clopidogrel, 18.2% on prasugrel, and 16.7% on ticagrelor).…”

Section: Discussionmentioning

confidence: 99%

“…In an observational study published by Gouffran et al [24], 10.9% of OHCA survivors treated with MTH had stent thrombosis (the latter occurred in 4.2% of patients on clopidogrel, 18.2% on prasugrel, and 16.7% on ticagrelor). Jiménez-Brítez et al [37] reported in-hospital stent thrombosis in 7.1% of patients, exclusively those treated with clopidogrel (11.4%), while no stent thrombosis occurred in patients on ticagrelor or prasugrel. Joffre et al [23] found cardiac arrest treated with MTH to be an independent risk factor for confirmed stent thrombosis (odds ratio = 12.9; 95% confidence interval 1.3-124.6, p = 0.027) regardless of the type of P2Y 12 antagonist.…”

Section: Discussionmentioning

confidence: 99%

Impact of mild therapeutic hypothermia on bioavailability of ticagrelor in patients with acute myocardial infarction after out-of-hospital cardiac arrest

et al. 2020

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Background: Out-of-hospital cardiac arrest (OHCA) frequently occurs in the early phase of acute myocardial infarction (MI). Survivors require percutaneous coronary intervention (PCI) with concomitant dual antiplatelet therapy. Target temperature management, including mild therapeutic hypothermia (MTH), should be applied in comatose patients after resuscitation. However, an increased risk of stent thrombosis in patients undergoing hypothermia is observed. The aim of this study was to assess the impact of MTH on pharmacokinetics of ticagrelor in cardiac arrest survivors with MI treated with MTH and PCI. Methods: In a prospective, observational, single-center study pharmacokinetics of ticagrelor were evaluated in 41 MI patients, including 11 patients after OHCA undergoing MTH (MTH group) and 30 MI patients without OHCA and MTH (no-MTH group). Blood samples were drawn before administration of a 180 mg ticagrelor loading dose, and 30 min, 1, 2, 4, 6, 12, and 24 h after the loading dose. Results: In patients treated with MTH total exposure to ticagrelor during the first 12 h after the loading dose and maximal plasma concentration of ticagrelor were significantly lower than in the no-MTH group : 3403 ± 2879 vs. 8746 ± 5596 ng·h/mL, difference: 61%, p = 0.01; C max : 475 ± 353 vs. 1568 ± 784 ng/mL, p = 0.0002). Time to achieve maximal ticagrelor plasma concentration was also delayed in the MTH group (t max for ticagrelor: 12 [6-24] vs. 4 [2-12] h, p = 0.01). Conclusions: Bioavailability of ticagrelor was substantially decreased and delayed in MI patients treated with MTH after OHCA. Trial registration: ClinicalTrials.gov Identifier: NCT02611934 (Cardiol J XXXX; XX, X: xx-xx)

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The value of using polymorphisms in anti-platelet therapy

Haybar

Zayeri

2017

Front. Biol.

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Out-of-hospital cardiac arrest and stent thrombosis: Ticagrelor versus clopidogrel in patients with primary percutaneous coronary intervention under mild therapeutic hypothermia

Cited by 32 publications

References 27 publications

Clopidogrel Versus Newer P2Y12 Antagonists for Percutaneous Coronary Intervention in Patients with Out-of-Hospital Cardiac Arrest Managed with Therapeutic Hypothermia: A Meta-Analysis

Clopidogrel Versus Newer P2Y12 Antagonists for Percutaneous Coronary Intervention in Patients with Out-of-Hospital Cardiac Arrest Managed with Therapeutic Hypothermia: A Meta-Analysis

Impact of mild therapeutic hypothermia on bioavailability of ticagrelor in patients with acute myocardial infarction after out-of-hospital cardiac arrest

The value of using polymorphisms in anti-platelet therapy

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