PDF(Pubmed)
Abstract：
Background: Comatose survivors of out-of-hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI) and target temperature management (TTM) are at increased risk of stent thrombosis (ST), partly due to delayed platelet inhibition even with more potent P2Y12 agents. We hypothesized that periprocedural cangrelor would induce immediate platelet inhibition, bridging the \"P2Y12 inhibition gap\". Methods: In our pilot study, we randomized 30 comatose OHCA patients undergoing PCI and TTM (32-34 °C) into cangrelor and control groups. Both groups received unfractioned heparin, acetylsalicylic acid, and ticagrelor via enteral tube. The cangrelor group also received an intravenous bolus of cangrelor followed by a 4 h infusion. Platelet inhibition was measured using VerifyNow® and Multiplate® ADP at baseline and 1, 3, 5, and 8 h post PCI. Results: Patient characteristics did not differ between groups. VerifyNow® showed significantly decreased platelet reactivity with cangrelor at 1 h (30 vs. 221 PRU; p < 0.001) and 3 h (24 vs. 180 PRU; p < 0.001), with differences at 5 and 8 h. Similarly, the proportion of patients with high on-treatment platelet reactivity (HPR) in the cangrelor group was significantly lower at 1 h (0% vs. 67%; p < 0.001) and 3 h (0% vs. 47%; p = 0.007). Multiplate® ADP was also decreased at 1 h (14 vs. 48 U; p < 0.001) and 3 h (11 vs. 42 U; p = 0.001), with no difference at 5 and 8 h. The occurrence of bleeding events was similar in both groups. Conclusions: Cangrelor safely induced immediate and profound platelet inhibition. We observed no significant drug-drug interaction with ticagrelor.
摘要：
背景：接受经皮冠状动脉介入治疗（PCI）和目标温度管理（TTM）的院外心脏骤停（OHCA）的昏迷幸存者支架内血栓形成（ST）的风险增加，部分原因是即使使用更有效的P2Y12药物，血小板抑制作用也会延迟。我们假设围手术期cangrelor会立即诱导血小板抑制，桥接“P2Y12抑制间隙”。方法：在我们的试点研究中，我们将30例接受PCI和TTM(32-34°C)的昏迷OHCA患者随机分为坎格雷洛组和对照组.两组均接受未分割的肝素，乙酰水杨酸,和替格瑞洛通过肠管。坎格雷洛组还接受了坎格雷洛的静脉推注，然后输注4小时。使用VerifyNow®和Multiplate®ADP在基线和PCI后1、3、5和8小时测量血小板抑制。结果：患者特征在组间没有差异。VerifyNow®在1h时显示与坎格雷洛的血小板反应性显着降低（30vs.221PRU；p<0.001）和3h（24vs.180PRU；p<0.001），在5和8小时有差异。同样，Cangrelor组中治疗中血小板反应性高（HPR）的患者比例在1h时显着降低（0％vs.67%；p<0.001）和3h（0%vs.47%；p=0.007）。Multiplate®ADP在1小时时也降低(14与48U；p<0.001）和3h（11vs.42U；p=0.001），5和8h时无差异。两组出血事件的发生率相似。结论：坎格雷洛安全地诱导了立即和深刻的血小板抑制。我们没有观察到与替格瑞洛的显著药物-药物相互作用。
