Impaired biological response to aspirin in therapeutic hypothermia comatose patients resuscitated from out-of-hospital cardiac arrest. (August 2016)

• Record Type: Journal Article
• Authors: Llitjos, Jean-François; Sideris, Georgios; Voicu, Sebastian; Bal Dit Sollier, Claire; Deye, Nicolas; Megarbane, Bruno; Drouet, Ludovic; Henry, Patrick; Dillinger, Jean-Guillaume
• Is Part Of: Resuscitation. Volume 105(2016)
• Page Start: 16
• Page End: 21
• Publication Date: 2016-08
• Subjects: ADP adenosine diphosphate -- CAD coronary artery disease -- HPR high platelet reactivity -- LTA-AA light transmission aggregometry with arachidonic acid -- LTA-ADP light transmission agregometry with adenosine diphosphate -- MAI maximum aggregation intensity -- OHCA out-of-hospital cardiac arrest -- PFA-Epi platelet function analyzer-100 with collagen-epinephrin -- ROSC return of spontaneous circulation -- ST stent thrombosis -- VASP-PRI vasodilatator-stimulated phosphoprotein platelet reactivity index; Cardiac arrest -- Aspirin -- Aggregation -- Platelets; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2016.04.027
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim of the study: Acute coronary syndrome is one of the main causes of out-of-hospital cardiac arrest (OHCA). OHCA patients are particularly exposed to high platelet reactivity (HPR) under aspirin (ASA) treatment. The aim was to evaluate HPR-ASA in therapeutic hypothermia comatose patients resuscitated from OHCA. Methods and results: Twenty-two consecutive patients with OHCA of cardiac origin were prospectively included after therapeutic hypothermia and randomized to receive ASA 100 mg per day, either intravenously ( n = 13) or orally via a gastric tube ( n = 9). ADP inhibitors (prasugrel or, if contra-indicated, clopidogrel) were administered in the event of angioplasty. HPR-ASA was assessed by light transmission aggregometry (LTA) with arachidonic acid (AA) and by the PFA-100 ® system with collagen/epinephrine. Clinical, biological and angiographic characteristics were similar in both groups. Using LTA-AA, maximum aggregation intensity was significantly lower in the intravenous group compared to the oral group (15% vs. 29%, respectively; p = 0.04). Overall, 10 patients (45%) had HPR-ASA (38% intravenously vs 56% orally; p = 0.7). Similarly, closure time was significantly increased in the IV group (277 s vs. 155 s, respectively; p = 0.04). Conclusion: This study suggests that impaired response to both intravenous and oral aspirin is frequent in comatose patients resuscitated from OHCA.