Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology CEPT, Medical University of Warsaw, Warsaw, Poland.
Department of Cardiology, Medical University of Vienna, Wien, Austria.
Clin Pharmacol Ther. 2019 Nov;106(5):993-1005. doi: 10.1002/cpt.1492. Epub 2019 Jul 1.
Out-of-hospital cardiac arrest is among the most frequent causes of death worldwide. Immediate intervention, as well as dual antiplatelet therapy consisting of acetylsalicylic acid and a P2Y inhibitor is often recommended. In line with the growing number of reports on cardiac arrest treatment, therapeutic hypothermia (TH) has been proposed for unconscious patients to improve neurological outcomes. Nevertheless, studies report controversial and often discrepant results on the effect of hypothermia on blood coagulability and platelet reactivity. In this review, we summarize the knowledge on platelet function under diverse hypothermic conditions. Additionally, we review the current literature on the effect of systemic hypothermia on pharmacokinetic and pharmacodynamic properties of antiplatelet agents. It has been shown that TH can alter the effectiveness of antiplatelet agents, including P2Y inhibitors, through multiple mechanisms, hence, special attention should be paid while implementing antiplatelet therapy in patients under TH conditions.
院外心脏骤停是全球最常见的死亡原因之一。通常建议立即进行干预，并采用包含乙酰水杨酸和 P2Y 抑制剂的双联抗血小板治疗。随着越来越多关于心脏骤停治疗的报告，有人提出对无意识患者进行治疗性低温（therapeutic hypothermia，TH）以改善神经预后。然而，关于低温对血液凝固性和血小板反应性的影响，研究报告的结果存在争议，且往往存在差异。在这篇综述中，我们总结了不同低温条件下血小板功能的相关知识。此外，我们还回顾了关于全身低温对抗血小板药物药代动力学和药效学特性影响的现有文献。已经表明，TH 可以通过多种机制改变抗血小板药物的有效性，包括 P2Y 抑制剂，因此，在 TH 条件下实施抗血小板治疗时应特别注意。
