title: Impaired biological response to aspirin in therapeutic hypothermia comatose patients resuscitated from out-of-hospital cardiac arrest.
abstract: 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.
  
  
  
  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).
  
  
  
  This study suggests that impaired response to both intravenous and oral aspirin is frequent in comatose patients resuscitated from OHCA.
authors.affiliation: Department of Cardiology - Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Llitjos
authors.affiliation: Department of Cardiology - Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sideris
authors.affiliation: Department of Medical and Toxicological Critical Care, Inserm U1144, Lariboisiere Hospital, AP-HP, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Voicu
authors.affiliation: Thrombosis and Atherosclerosis Research Unit, Vessels and Blood Institute (IVS), Anticoagulation Clinic (CREATIF), Lariboisiere Hospital, and Paris VII University EA 7334 REMES, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bal Dit Sollier
authors.affiliation: Department of Medical and Toxicological Critical Care, Inserm U1144, Lariboisiere Hospital, AP-HP, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.affiliation: Department of Medical and Toxicological Critical Care, Inserm U1144, Lariboisiere Hospital, AP-HP, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Megarbane
authors.affiliation: Thrombosis and Atherosclerosis Research Unit, Vessels and Blood Institute (IVS), Anticoagulation Clinic (CREATIF), Lariboisiere Hospital, and Paris VII University EA 7334 REMES, Paris, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Drouet
authors.affiliation: Department of Cardiology - Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
authors.affiliation: Department of Cardiology - Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Sorbonne Paris Cité, Paris, France; Thrombosis and Atherosclerosis Research Unit, Vessels and Blood Institute (IVS), Anticoagulation Clinic (CREATIF), Lariboisiere Hospital, and Paris VII University EA 7334 REMES, Paris, France. Electronic address: jean-guillaume.dillinger@aphp.fr.
authors.forename: Jean-Guillaume
authors.initials: JG
authors.lastname: Dillinger
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy*; D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D016887:Cardiopulmonary Resuscitation; D000077144:Clopidogrel; D003128:Coma / Q000097:blood*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage; D011446:Prospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin
keywords: Aggregation; Aspirin; Cardiac arrest; Platelets