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Journal of Thrombosis and Thrombolysis

Erschienen in:

04.09.2015

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

verfasst von: Frantisek Bednar, Josef Kroupa, Martina Ondrakova, Pavel Osmancik, Milos Kopa, Zuzana Motovska

Erschienen in: Journal of Thrombosis and Thrombolysis | Ausgabe 4/2016

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Abstract

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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Titel: Antiplatelet efficacy of P2Y12 inhibitors (prasugrel, ticagrelor, clopidogrel) in patients treated with mild therapeutic hypothermia after cardiac arrest due to acute myocardial infarction
verfasst von: Frantisek Bednar
Josef Kroupa
Martina Ondrakova
Pavel Osmancik
Milos Kopa
Zuzana Motovska
Publikationsdatum: 04.09.2015
Verlag: Springer US
Erschienen in: Journal of Thrombosis and Thrombolysis / Ausgabe 4/2016
Print ISSN: 0929-5305
Elektronische ISSN: 1573-742X
DOI: https://doi.org/10.1007/s11239-015-1274-7

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