Balancing thrombosis and bleeding after out-of-hospital cardiac arrest related to acute coronary syndrome: A literature review

Gall, Emmanuel; Lafont, A.; Varenne, Olivier; Dumas, Florence; Cariou, Alain; Picard, Fabien

doi:10.1016/j.acvd.2021.07.002

Cited by 11 publications

(8 citation statements)

References 79 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Indeed, it might be interesting to know which types of lesions were considered "acute culprit lesions" and were treated. Some might have been treated without any expected benefit on mortality but with unnecessary inherent risk of complications such as thrombosis or bleeding events following percutaneous angioplasty, especially in the setting of OHCA [37]. In addition, femoral access was used in 72.0% of cases, which could also have led to increased hemorrhagic complications.…”

Section: Current Evidencementioning

confidence: 99%

Percutaneous Coronary Intervention in Out-of-Hospital Cardiac Arrest Related to Acute Coronary Syndrome: A Literature Review

Gall,

Mafi,

Ghannam

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

Out-of-hospital cardiac arrest (OHCA) continues to be a major global cause of death, affecting approximately 67 to 170 per 100,000 inhabitants annually in Europe, with a persisting high rate of mortality of up to 90% in most countries. Acute coronary syndrome (ACS) represents one of the most significant cause of cardiac arrest, and therefore invasive coronary angiography (CAG) with subsequent percutaneous coronary intervention (PCI) has emerged as a fundamental component in the management of OHCA patients. Recent evidence from large randomized controlled trials (RCTs) challenges the routine use of early CAG in the larger subgroup of patients with non-ST segment elevation myocardial infarction (NSTEMI). Additionally, emerging data suggest that individuals resuscitated from OHCA related to ACS face an elevated risk of thrombotic and bleeding events. Thus, specific invasive coronary strategies and anti-thrombotic therapies tailored to this unique setting of OHCA need to be considered for optimal in-hospital management. We sought to provide an overview of the prevalence and complexity of coronary artery disease observed in this specific population, discuss the rationale and timing for CAG after return of spontaneous circulation (ROSC), summarize invasive coronary strategies, and examine recent findings on antithrombotic therapies in the setting of ACS complicated by OHCA. By synthesizing the existing knowledge, this review aims to contribute to the understanding and optimization of care for OHCA patients to improve outcomes in this challenging clinical scenario.

show abstract

Section: Current Evidencementioning

confidence: 99%

Percutaneous Coronary Intervention in Out-of-Hospital Cardiac Arrest Related to Acute Coronary Syndrome: A Literature Review

Gall,

Mafi,

Ghannam

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…Es un método no invasivo, que solamente necesita el uso de un ecógrafo, y la valoración de un técnico especialista que encuentre hallazgos característicos como es una disminución de la vena cava inferior, ya que permite determinar la velocidad con la que llega la sangre hacia la bomba cardiaca, una complicación consiste en que el ecógrafo no capta la variación mínima sino capta cuando existe una disminución del gasto cardiaco excesiva, comprometiendo la vida del paciente conforme pasa las horas (Gall et al, 2021).…”

Section: Ecografía Clínicaunclassified

“…La hipotermia inducida tiene un efecto neuroprotector, debido a que el cuerpo entra en un proceso de consumo de oxígeno disminuido, creando que las células neuronales retengan el poco oxígeno en su interior sin entrar en una fase de hipoxemia y por consiguiente necrosis causando daño cerebral, además, que ralentiza la activación de aminoácidos y radicales libres, disminuyendo que se produzca la activación de la muerte neuronal (Gall et al, 2021).…”

Section: Hipotermia Inducidaunclassified

Revisión del Síndrome Post Parada Cardíaca

Iñiguez¹,

Molina²,

Hernández³

et al. 2023

LATAM

View full text Add to dashboard Cite

El síndrome postparada cardiaca se define como una disfunción circulatoria que precipita un estado hipoxémico, acidótico e isquémico generalizado, que a su vez genera lesiones sistémicas en órganos diana traducidas como depresión miocárdica, vasoespasmo, exocitosis, inflamación y necrosis. Su etiología desencadenante suele ser identificada durante el proceso de reanimación cardiopulmonar, por lo que requiere un manejo terapéutico inmediato, enfocado a conseguir la estabilización del paciente y la consiguiente recuperación espontánea de la circulación global; Sin embargo, el pronóstico es reservado, variable y dependiente de la sobrevida de cada paciente.

show abstract

“…Overall bleeding complications in OHCA range from 15-20%, and increase to 31-32% in patients treated with eCPR or MCS [29][30][31][32]. Mechanical CPR and MCS themselves are associated with increased bleeding risk, and in MCS, access-site bleeding is a frequent complication [33,34]. Current registry data are in line with prior publications, but one should bear in mind that RBC transfusion is an unspecific bleeding event and OHCA patients are at increased bleeding risk even in the absence of antithrombotic/anticoagulatory pretreatment.…”

Section: Bleedingmentioning

confidence: 99%

Outcome of Out-of-Hospital Cardiac Arrest Patients Stratified by Pre-Clinical Loading with Aspirin and Heparin: A Retrospective Cohort Analysis

Macherey-Meyer

Heyne

Meertens

et al. 2023

JCM

View full text Add to dashboard Cite

Background: Out-of-hospital cardiac arrest (OHCA) has a high prevalence of obstructive coronary artery disease and total coronary occlusion. Consequently, these patients are frequently loaded with antiplatelets and anticoagulants before hospital arrival. However, OHCA patients have multiple non-cardiac causes and high susceptibility for bleeding. In brief, there is a gap in the evidence for loading in OHCA patients. Objective: The current analysis stratified the outcome of patients with OHCA according to pre-clinical loading. Material and Methods: In a retrospective analysis of an all-comer OHCA registry, patients were stratified by loading with aspirin (ASA) and unfractionated heparin (UFH). Bleeding rate, survival to hospital discharge and favorable neurological outcomes were measured. Results: Overall, 272 patients were included, of whom 142 were loaded. Acute coronary syndrome was diagnosed in 103 patients. One-third of STEMIs were not loaded. Conversely, 54% with OHCA from non-ischemic causes were pretreated. Loading was associated with increased survival to hospital discharge (56.3 vs. 40.3%, p = 0.008) and a more favorable neurological outcome (80.7 vs. 62.6% p = 0.003). Prevalence of bleeding was comparable (26.8 vs. 31.5%, p = 0.740). Conclusions: Pre-clinical loading did not increase bleeding rates and was associated with favorable survival. Overtreatment of OHCA with non-ischemic origin, but also undertreatment of STEMI-OHCA were documented. Loading without definite diagnosis of sustained ischemia is debatable in the absence of reliable randomized controlled data.

show abstract

Balancing thrombosis and bleeding after out-of-hospital cardiac arrest related to acute coronary syndrome: A literature review

Cited by 11 publications

References 79 publications

Percutaneous Coronary Intervention in Out-of-Hospital Cardiac Arrest Related to Acute Coronary Syndrome: A Literature Review

Percutaneous Coronary Intervention in Out-of-Hospital Cardiac Arrest Related to Acute Coronary Syndrome: A Literature Review

Revisión del Síndrome Post Parada Cardíaca

Outcome of Out-of-Hospital Cardiac Arrest Patients Stratified by Pre-Clinical Loading with Aspirin and Heparin: A Retrospective Cohort Analysis

Contact Info

Product

Resources

About