title: Platelet reactivity in comatose survivors of cardiac arrest undergoing percutaneous coronary intervention and hypothermia.
abstract: OBJECTIVE
  To investigate the effects of clopidogrel and eptifibatide on platelet reactivity in patients resuscitated from cardiac arrest undergoing percutaneous coronary intervention (PCI) and hypothermia.
  
  
  RESULTS
  VerifyNow® and Multiplate® aggregometry were used before, and 4, 12, 22 and 48 hours after 600 mg clopidogrel treatment in 28 post-cardiac arrest hypothermic patients and in 14 normothermic patients with acute coronary syndrome. Basal platelet reactivity after stimulation with iso-thrombin receptor-activating peptide (TRAP) and PAR4-activating peptide (BASE) was significantly lower in the post-cardiac arrest group and persisted up to 48 hours. The antiplatelet effect of clopidogrel measured by VerifyNow and expressed as % inhibition was significantly lower in the post-cardiac arrest group. It was close to zero with an increase to only around 10% after 48 hours. Post-cardiac arrest patients receiving eptifibatide showed profound platelet inhibition measured by both VerifyNow IIb/IIIa and Multiplate TRAP tests for at least 22 hours after administration.
  
  
  CONCLUSIONS
  Post-resuscitation syndrome with ongoing hypothermia is associated with decreased platelet reactivity. Clopidogrel loading does not significantly affect platelet function during the first 48 hours. This is in contrast with eptifibatide which produces profound platelet inhibition, and may be used to bridge insufficient inhibition by clopidogrel.
authors.affiliation: Centre for Intensive Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Klemen
authors.initials: K
authors.lastname: Steblovnik
authors.forename: Ales
authors.initials: A
authors.lastname: Blinc
authors.forename: Mojca
authors.initials: M
authors.lastname: Bozic-Mijovski
authors.forename: Igor
authors.initials: I
authors.lastname: Kranjec
authors.forename: Enver
authors.initials: E
authors.lastname: Melkic
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000187:drug effects*; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D000077144:Clopidogrel; D015331:Cohort Studies; D003128:Coma / Q000209:etiology; D017023:Coronary Angiography; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000150:complications / Q000628:therapy; D010455:Peptides / Q000494:pharmacology*; D062645:Percutaneous Coronary Intervention; D015539:Platelet Activation / Q000187:drug effects; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*; D011446:Prospective Studies; D018179:Receptors, Thrombin; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology
chemical_list: D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D018179:Receptors, Thrombin; D000077144:Clopidogrel; D000077542:Eptifibatide; D013988:Ticlopidine