Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Can J Cardiol. 2014 Nov;30(11):1396-9. doi: 10.1016/j.cjca.2014.07.745. Epub 2014 Aug 15.
Current guidelines suggest that patients undergoing percutaneous coronary intervention (PCI) receive dual-antiplatelet therapy. There are limited data on the pharmacodynamics of P2Y12 inhibitors in patients with cardiac arrest and return of spontaneous circulation (ROSC) undergoing PCI and therapeutic hypothermia (TH). Accordingly, we compared inhibition of platelet reactivity in patients undergoing TH receiving clopidogrel or ticagrelor. Notably, clopidogrel was ineffective in lowering platelet reactivity, with ticagrelor providing a more rapid (within 4 hours) and sustained reduction (6 days) in platelet reactivity. Pending outcome-based studies, ticagrelor should be used preferentially in patients who have ROSC and are undergoing PCI and TH.
目前的指南建议行经皮冠状动脉介入治疗（PCI）的患者接受双联抗血小板治疗。关于在接受心脏骤停和自主循环恢复（ROSC）并接受 PCI 和治疗性低温（TH）的患者中，P2Y12 抑制剂的药效动力学数据有限。因此，我们比较了在接受 TH 的患者中氯吡格雷或替格瑞洛对血小板反应性的抑制作用。值得注意的是，氯吡格雷不能有效降低血小板反应性，而替格瑞洛则能更快（4 小时内）和更持久（6 天）地降低血小板反应性。在基于结果的研究中，在有 ROSC 并接受 PCI 和 TH 的患者中，应优先使用替格瑞洛。
