Safety of glycoprotein IIb/IIIa inhibitors in patients under therapeutic hypothermia admitted for an acute coronary syndrome

Jiménez-Brítez, Gustavo; Freixa, Xavier; Flores, Eduardo; Penela, Diego; Hernández-Enrı́quez, Marco; Antonio, Rodolfo San; Caixal, Gala; Garcia, Julien; Roqué, Mercè; Martín, Virginia; Brugaletta, Salvatore; Masotti, Mónica; Sabaté, Manel

doi:10.1016/j.resuscitation.2016.06.031

Cited by 14 publications

(9 citation statements)

References 23 publications

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“…[54][55][56][57] In patients with a large thrombus burden, bolus doses of glycoprotein IIb/IIIa inhibitors may be considered after carefully weighing against the increased risk of bleeding. 58 Cangrelor, an intravenous P2 Y12 inhibitor may be an option to use in these patients as a bridge during delayed absorption of oral agents. 59 (Figure 2).…”

Section: Antiplatelet Therapymentioning

confidence: 99%

“…As demonstrated in patients with STEMI without cardiac arrest, the newer oral antiplatelet agents (ticagrelor and prasugrel) in addition to aspirin may be associated with reduced risk of ST even among comatose OHCA patients and are favored over clopidogrel 54‐57 . In patients with a large thrombus burden, bolus doses of glycoprotein IIb/IIIa inhibitors may be considered after carefully weighing against the increased risk of bleeding 58 . Cangrelor, an intravenous P2 Y12 inhibitor may be an option to use in these patients as a bridge during delayed absorption of oral agents 59 …”

Section: Access and Peri‐procedural Antithombotic Therapy During Pci mentioning

confidence: 99%

See 1 more Smart Citation

SCAI expert consensus statement on out of hospital cardiac arrest

Lotfi

Klein

Hira

et al. 2020

Cathet Cardio Intervent

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Section: Antiplatelet Therapymentioning

confidence: 99%

Section: Access and Peri‐procedural Antithombotic Therapy During Pci mentioning

confidence: 99%

SCAI expert consensus statement on out of hospital cardiac arrest

Lotfi

Klein

Hira

et al. 2020

Cathet Cardio Intervent

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“…66 In a single-center observational study of 110 survivors of OHCA with mild hypothermia treatment, the use of GPI was related to higher rates of bleeding events (41.1% vs. 3.7% for major bleeding, P < 0.0001) without any reduction on thrombotic events (11.2% vs. 11.1%, P = 0.941) compared with nonreceivers. 67 Because those patients carried an increased bleeding risk, according to the aforementioned outcomes, the use of GPIs should be considered for bailout situations at the discretion of interventionalists. Overall, because of the small size of the available clinical trials in OHCA survivors and because those patients usually undergo C-PCI (as the MI involves more often the LM and CTOs), more studies are needed to shed light on the periprocedural antithrombotic treatment in this complex clinical scenario.…”

Section: Antithrombotic Therapy During Pcimentioning

confidence: 99%

Periprocedural Antithrombotic Treatment in Complex Percutaneous Coronary Intervention

Vlachakis

Varlamos

Benetou

et al. 2022

Journal of Cardiovascular Pharmacology

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:In recent years, the management of complex lesions in patients undergoing percutaneous coronary intervention (PCI) constitutes a field of high interest and concern for the interventional cardiology. As more and more studies demonstrate the increased hazard of ischemic events in this group of patients, it is of paramount importance for the physicians to choose the optimal periprocedural (pre-PCI, during-PCI and post-PCI) antithrombotic treatment strategies wisely. Evidence regarding the safety and efficacy of current anticoagulation recommendation, the possible beneficial role of the pretreatment with a potent P2Y12 inhibitor in the subgroup of patients with non-ST segment elevation myocardial infarction with complex lesions, and the impact of a more potent P2Y12 inhibitor in individuals with stable coronary artery disease undergoing complex PCI are needed. This will provide and serve as a guide to clinicians to deploy the maximum efficacy of the current choices of antithrombotic therapy, which will lead to an optimal balance between safety and efficacy in this demanding clinical scenario.

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“…14 In 25 resuscitated ACS patients treated with TTM, cangrelor achieved greater platelet inhibition than oral P2Y12 inhibitors, without an increase in bleeding. 50 Routine use of GPI with TTM should be avoided because of the higher incidence of bleeding without significant improvement in outcome, 101 possibly attributable to TTM-mediated effects on platelet function that can be direct and indirect, through augmentation of GPI effects. 102…”

Section: Targeted Temperature Management (Ttm)mentioning

confidence: 99%

Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Gorog

Price

Sibbing

et al. 2020

European Heart Journal - Cardiovascular Pharmacotherapy

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Timely and effective antithrombotic therapy is critical to improving outcome, including survival, in patients with acute coronary syndrome (ACS). Achieving effective platelet inhibition and anticoagulation, with minimal risk, is particularly important in high-risk ACS patients, especially those with cardiogenic shock (CS) or those successfully resuscitated following out-of-hospital cardiac arrest (OHCA), who have a 30-50% risk of death or a recurrent ischaemic event over the subsequent 30 days. There are unique challenges to achieving effective and safe antithrombotic treatment in this cohort of patients that are not encountered in most other ACS patients. This position paper focuses on patients presenting with CS or immediately post-OHCA, of presumed ischaemic aetiology, and examines issues related to thrombosis and bleeding risk. Both the physical and pharmacological impacts of CS, namely impaired drug absorption, metabolism, altered distribution and/or excretion, associated multiorgan failure, co-morbidities and co-administered treatments such as opiates, targeted temperature management, renal replacement therapy and circulatory or left ventricular assist devices, can have major impact on the effectiveness and safety of antithrombotic drugs. Careful attention to the choice of antithrombotic agent(s), route of administration, drug-drug interactions, therapeutic drug monitoring and factors that affect drug efficacy and safety, may reduce the risk of sub- or supra-therapeutic dosing and associated adverse events. This paper provides expert opinion, based on best available evidence, and consensus statements on optimising antithrombotic therapy in these very high-risk patients, in whom minimising the risk of thrombosis and bleeding is critical to improving outcome.

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Safety of glycoprotein IIb/IIIa inhibitors in patients under therapeutic hypothermia admitted for an acute coronary syndrome

Cited by 14 publications

References 23 publications

SCAI expert consensus statement on out of hospital cardiac arrest

SCAI expert consensus statement on out of hospital cardiac arrest

Periprocedural Antithrombotic Treatment in Complex Percutaneous Coronary Intervention

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