Impaired biological response to aspirin in therapeutic hypothermia comatose patients resuscitated from out-of-hospital cardiac arrest

Resuscitation. 2016 Aug:105:16-21. doi: 10.1016/j.resuscitation.2016.04.027. Epub 2016 May 17.

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 100mg 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 (277s vs. 155s, 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.

Keywords: Aggregation; Aspirin; Cardiac arrest; Platelets.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / drug therapy*
  • Administration, Intravenous
  • Administration, Oral
  • Adult
  • Aged
  • Aspirin / administration & dosage
  • Aspirin / adverse effects*
  • Cardiopulmonary Resuscitation
  • Clopidogrel
  • Coma / blood*
  • Female
  • Humans
  • Hypothermia, Induced / methods*
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / etiology
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Platelet Aggregation / drug effects*
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Aggregation Inhibitors / adverse effects*
  • Platelet Function Tests
  • Prasugrel Hydrochloride / administration & dosage
  • Prospective Studies
  • Ticlopidine / administration & dosage
  • Ticlopidine / analogs & derivatives

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Prasugrel Hydrochloride
  • Ticlopidine
  • Aspirin