Adaptation of global hemostasis to therapeutic hypothermia in patients with out-of-hospital cardiac arrest: Thromboelastography study

Trąbka-Zawicki, Aleksander; Tomala, Marek; Zeliaś, Aleksander; Paszek, Elżbieta; Zajdel, Wojciech; Stępień, Ewa; Żmudka, Krzysztof

doi:10.5603/cj.a2017.0080

Cited by 11 publications

(14 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One potential mechanism behind the increased risk of bleeding in MTH-treated patients could be a decreased platelet count in blood serum persisting after re-warming. This is consistent with prior studies involving cooling patients [45] as well as coagulation disorders and most likely results from impaired production of clotting enzymes at temperatures below 32C, which was previously studied by our group and others [7,8].…”

Section: Discussionsupporting

confidence: 92%

Ticagrelor effectively inhibits platelet aggregation in comatose survivors of cardiac arrest undergoing primary percutaneous coronary intervention treated with mild therapeutic hypothermia

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background: Mild therapeutic hypothermia (MTH) is believed to reduce the effectiveness of antiplatelet drugs. Effective dual-antiplatelet therapy after percutaneous coronary intervention (PCI) is mandatory to avoid acute stent thrombosis (ST). The effectiveness of ticagrelor in MTH-treated out-of-hospital cardiac arrest (OHCA) survivors is still a matter of debate. The aim of the study was to evaluate the impact of MTH on the platelet-inhibitory effect of ticagrelor in comatose survivors of OHCA treated with primary PCI.Methods: Eighteen comatose survivors of OHCA with acute coronary syndrome undergoing immediate PCI treated with MTH were compared with 14 patients with uncomplicated primary myocardial infarction after PCI, matched for gender and age, in a prospective, single-center, observational study. Platelet aggregation was evaluated using VerifyNow P2Y12 pointof-care testing at 3 time points: admission (T0), during MTH (T1), and 48-72 h after rewarming (T2).Results: Ticagrelor effectively inhibits platelet aggregation in OHCA patients subjected to MTH and in all patients in the control group. The effectiveness of ticagrelor did not differ between the MTH group and the control group (p = 0.581). In 2 cases in the MTH population, the platelet response to ticagrelor was inadequate, and in one of them it remained insufficient during the re-warming phase. There was no stent thrombosis in these patients. Conclusions:The present study confirmed the effectiveness of ticagrelor to inhibit platelets in myocardial infarction patients after OHCA treated with primary PCI undergoing hypothermia. The use of cooling was not associated with an increased risk of stent thrombosis.

show abstract

Section: Discussionsupporting

confidence: 92%

Ticagrelor effectively inhibits platelet aggregation in comatose survivors of cardiac arrest undergoing primary percutaneous coronary intervention treated with mild therapeutic hypothermia

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…As both hemostatic pathways and physiological anticoagulant systems are affected, the ensuing balance between pro-and anticoagulant systems seems to prevent major clinical consequences such as major bleeding or thrombosis. 39 Animal studies in experimental posthypoxic hypothermia showed impairment of primary hemostasis, attenuated coagulation, and decreased activity of coagulation inhibitors. 40 Platelet function was more incisively studied in a series of 82 patients undergoing therapeutic cooling after out-of-hospital cardiac arrest, which confirmed an impairment of platelet function assessed by various techniques in hypothermic patients.…”

Section: Hemostasis and Hypothermiamentioning

confidence: 99%

“…43 A more precise study on coagulation function in 21 patients who were subjected to therapeutic cooling showed delayed clot formation, impaired clot stability, and enhanced endogenous fibrinolysis. 39 However, there is no evidence that even deep hypothermia causes an increased bleeding tendency. 38 Instead, there is some evidence that deep hypothermia may cause thrombotic complications, in particular at the site of catheters that are used to achieve the lowering of the body temperature.…”

Section: Hemostasis and Hypothermiamentioning

confidence: 99%

Hemostasis and Thrombosis in Extreme Temperatures (Hypo- and Hyperthermia)

Levi

2018

Semin Thromb Hemost

View full text Add to dashboard Cite

The delicate biochemistry of coagulation and anticoagulation is greatly affected by deviations from the optimal temperature required for the interactions between various coagulation enzymes, cellular receptors, and intracellular mechanisms. Hyperthermia will lead to a prothrombotic state and, if sufficiently severe such as in heatstroke, a consumption coagulopathy, which will clinically manifest with the simultaneous appearance of intravascular thrombotic obstruction and an increased bleeding tendency. Hypothermia slows down the coagulation process, but as this seems to be adequately balanced by impairment of anticoagulant and fibrinolytic processes, its clinical effects are modest; however, hypothermia may be modestly linked to a somewhat higher risk of localized thrombosis. Restoration of a normal body temperature in patients affected by hyper- or hypothermia is the cornerstone for the management of associated coagulation derangements.

show abstract

“…Hypothermia is known to induce coagulopathy, and this can have a significant impact on VHA output and interpretation. Several studies have shown that TEG ® measurements are significantly different from expected values in patients being treated for cardiac arrest with therapeutic hypothermia [110,114]. Similar effects have also been reported in neonates treated for hypothermia [115].…”

Section: Hypothermiamentioning

confidence: 75%

Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center

Lantry

Mason

Logsdon

et al. 2022

JCM

View full text Add to dashboard Cite

Modern approaches to resuscitation seek to bring patient interventions as close as possible to the initial trauma. In recent decades, fresh or cold-stored whole blood has gained widespread support in multiple settings as the best first agent in resuscitation after massive blood loss. However, whole blood is not a panacea, and while current guidelines promote continued resuscitation with fixed ratios of blood products, the debate about the optimal resuscitation strategy—especially in austere or challenging environments—is by no means settled. In this narrative review, we give a brief history of military resuscitation and how whole blood became the mainstay of initial resuscitation. We then outline the principles of viscoelastic hemostatic assays as well as their adoption for providing goal-directed blood-component therapy in trauma centers. After summarizing the nascent research on the strengths and limitations of viscoelastic platforms in challenging environmental conditions, we conclude with our vision of how these platforms can be deployed in far-forward combat and austere civilian environments to maximize survival.

show abstract

Adaptation of global hemostasis to therapeutic hypothermia in patients with out-of-hospital cardiac arrest: Thromboelastography study

Abstract: (Cardiol J 2019; 26, 1: 77-86)

Cited by 11 publications

References 39 publications

Ticagrelor effectively inhibits platelet aggregation in comatose survivors of cardiac arrest undergoing primary percutaneous coronary intervention treated with mild therapeutic hypothermia

Ticagrelor effectively inhibits platelet aggregation in comatose survivors of cardiac arrest undergoing primary percutaneous coronary intervention treated with mild therapeutic hypothermia

Hemostasis and Thrombosis in Extreme Temperatures (Hypo- and Hyperthermia)

Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center

Contact Info

Product

Resources

About