Platelet aggregation and clot formation in comatose survivors of cardiac arrest treated with induced hypothermia and dual platelet inhibition with aspirin and ticagrelor; a prospective observational study

Kander, Thomas; Dankiewicz, Josef; Friberg, Hans; Schött, Ulf

doi:10.1186/s13054-014-0495-z

Cited by 24 publications

(31 citation statements)

References 46 publications

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“…The authors explained that Sonoclot and thromboelastography fail to detect changes in platelet activation, whereas flow cytometry is designed to do this. Similar conflicting results were found in respect to TH and ticagrelor based on in vivo and in vitro designs . This finding is particularly interesting due to the unique study design, in which researchers eliminated the possible risk of poor intestinal absorption on the outcome .…”

Section: Th and Asamentioning

confidence: 58%

“…The effect of P2Y 12 ‐antagonists can be detected with flow cytometry–based VASP analysis and, as described above, it was decreased when clopidogrel was given during mild hypothermia . This can explain the discrepant findings between Multiplate and Sonoclot with VASP analyses in the study conducted by Kander et al . Moreover, a strong correlation between gastric emptying and VASP during hypothermia indicated that delayed gastric emptying could be responsible for the limited ticagrelor effect.…”

Section: Th and P2y12 Inhibitorsmentioning

confidence: 95%

“…Mild hypothermia was related to enhanced platelet activation defined as upregulation of PAC‐1 and P‐selectin on the platelet surface measured with flow cytometry. As discussed above, the powerful platelet inhibition, exerted by ASA and P2Y 12 blockade, is not detectable by Sonoclot in vivo analyses . This finding is particularly interesting due to the unique study design, in which researchers eliminated the possible risk of poor intestinal absorption on the outcome .…”

Section: Th and Asamentioning

confidence: 96%

“…As discussed above, the powerful platelet inhibition, exerted by ASA and P2Y 12 blockade, is not detectable by Sonoclot in vivo analyses . This finding is particularly interesting due to the unique study design, in which researchers eliminated the possible risk of poor intestinal absorption on the outcome . To conclude, in patients with ACS treated with ticagrelor and ASA in vitro , hypothermia of 33°C was associated with an increased platelet activity determined with flow cytometry with lack of effect on Multiplate aggregometry, and a hypocoagulative response in viscoelastic coagulation test (Sonoclot) .…”

Section: Th and Asamentioning

confidence: 98%

“…Sonoclot analyses showed that both clot rate and platelet function were higher at normothermia compared with hypothermia; however, VASP analyses revealed significantly decreased results. It is worth noticing that viscoelastic tests, such as Sonoclot analyses, do not detect ASA or P2Y 12 ‐antagonist effects on hemostasis . The effect of P2Y 12 ‐antagonists can be detected with flow cytometry–based VASP analysis and, as described above, it was decreased when clopidogrel was given during mild hypothermia .…”

Section: Th and P2y12 Inhibitorsmentioning

confidence: 99%

See 4 more Smart Citations

Effectiveness of Antiplatelet Drugs Under Therapeutic Hypothermia: A Comprehensive Review

Eyileten

Pordzik

Siller-Matula

et al. 2019

Clin Pharma and Therapeutics

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Out‐of‐hospital cardiac arrest is among the most frequent causes of death worldwide. Immediate intervention, as well as dual antiplatelet therapy consisting of acetylsalicylic acid and a P2Y12 inhibitor is often recommended. In line with the growing number of reports on cardiac arrest treatment, therapeutic hypothermia (TH) has been proposed for unconscious patients to improve neurological outcomes. Nevertheless, studies report controversial and often discrepant results on the effect of hypothermia on blood coagulability and platelet reactivity. In this review, we summarize the knowledge on platelet function under diverse hypothermic conditions. Additionally, we review the current literature on the effect of systemic hypothermia on pharmacokinetic and pharmacodynamic properties of antiplatelet agents. It has been shown that TH can alter the effectiveness of antiplatelet agents, including P2Y12 inhibitors, through multiple mechanisms, hence, special attention should be paid while implementing antiplatelet therapy in patients under TH conditions.

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Section: Th and Asamentioning

confidence: 58%

Section: Th and P2y12 Inhibitorsmentioning

confidence: 95%

Section: Th and Asamentioning

confidence: 96%

Section: Th and Asamentioning

confidence: 98%

Section: Th and P2y12 Inhibitorsmentioning

confidence: 99%

See 3 more Smart Citations

Effectiveness of Antiplatelet Drugs Under Therapeutic Hypothermia: A Comprehensive Review

Eyileten

Pordzik

Siller-Matula

et al. 2019

Clin Pharma and Therapeutics

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Hypothermia During Microsurgical Head and Neck Reconstruction and Incidence of Venous Thromboembolism

Saadoun,

Guerrero,

Bengur

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceVenous thromboembolism (VTE) is a severe complication after microsurgical free tissue transfer (FTT) to the head and neck. Hypothermia during surgery is a modifiable risk factor, and avoiding it may reduce the postoperative VTE rate.ObjectiveTo assess the association between hypothermia (temperature &lt;36 °C) and postoperative VTE and free flap pedicle thrombosis rates after head and neck reconstruction with FTT.Design, Setting, and ParticipantsThis retrospective cohort study in a tertiary academic referral center used prospective and retrospective database and medical record data collected for patients who underwent head and neck reconstruction with FTT between January 1, 2012, and August 31, 2023. Temperature over time was classified as normothermia (temperature ≥36 °C), hypothermia (&lt;36 °C) for more than 30 minutes and less than 120 minutes, and hypothermia for 120 minutes or more.ExposureVenous thromboembolism.Main Outcomes and MeasuresThe study outcomes were VTE events and thrombosis of the free flap pedicle that required revision surgery. Univariable and multivariable regressions were used to test the association between the outcomes and clinical factors.ResultsA total of 1078 patients (mean [SD] age, 61.3 [12.6] years; 724 males [67.2%]; mean [SD] Caprini score, 6.4 [2.1]) were included. The VTE and pedicle thrombosis rates were 3.2% (35 patients) and 2.2% (24 patients), respectively. In a multivariable model controlled for Caprini score and chemoprophylaxis, VTE was associated with hypothermia of more than 30 minutes and less than 120 minutes (odds ratio [OR], 3.82; 95% CI, 0.99-14.07) and hypothermia of 120 minutes or longer (OR, 3.55; 95% CI, 1.05-11.95). Free flap pedicle thrombosis was not associated with hypothermia (OR, 0.61; 95% CI, 0.26-1.43).Conclusions and RelevanceThese findings suggest that preventing hypothermia during microsurgical FTT to the head and neck may decrease the postoperative rate of VTE. Future studies should explore the optimal intraoperative body temperature range that may prevent the development of VTE without compromising patient safety.

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Efficacy of enteral ticagrelor in hypothermic patients after out-of-hospital cardiac arrest

et al. 2015

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IntroductionDelivery of crushed ticagrelor via a nasogastric tube is a widely spread off-label use in unconscious patients following out-of-hospital cardiac arrest (OHCA). Notwithstanding the importance of a potent dual antiplatelet therapy in these patients, the efficacy of crushed ticagrelor after OHCA has not been established yet.MethodsIn a prospective, single-center, observational trial, 38 consecutive MI patients after OHCA were included. 27 patients (71.1 %) underwent mild induced hypothermia. The primary outcome was platelet inhibition at 24h measured by impedance aggregometry.ResultsThere was sufficient platelet inhibition in most patients after OHCA. In all hypothermic patients, there was an adequate platelet inhibition by ticagrelor at 24 h (p < 0.001). 15 patients (39.5 %) had significant gastroesophageal reflux and one patient with significant reflux had inadequate platelet inhibition at 24 h. There were no stent thrombosis or recurrent atherothrombotic events in these patients.ConclusionAdministration of crushed ticagrelor via a nasogastric tube reliably inhibited platelet function in vitro and in vivo regardless of the presence of hypothermia in MI patients. Thus, platelet inhibition can be reliably achieved in MI patients during neuroprotective hypothermia following OHCA.

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Platelet aggregation and clot formation in comatose survivors of cardiac arrest treated with induced hypothermia and dual platelet inhibition with aspirin and ticagrelor; a prospective observational study

Cited by 24 publications

References 46 publications

Effectiveness of Antiplatelet Drugs Under Therapeutic Hypothermia: A Comprehensive Review

Effectiveness of Antiplatelet Drugs Under Therapeutic Hypothermia: A Comprehensive Review

Hypothermia During Microsurgical Head and Neck Reconstruction and Incidence of Venous Thromboembolism

Efficacy of enteral ticagrelor in hypothermic patients after out-of-hospital cardiac arrest

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