Ticagrelor Versus Clopidogrel in Comatose Survivors of Out-of-Hospital Cardiac Arrest Undergoing Percutaneous Coronary Intervention and Hypothermia
A Randomized Study
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Comatose survivors of out-of-hospital cardiac arrest increasingly undergo immediate percutaneous coronary intervention (PCI) and stenting, which is associated with the need for administration of P2Y12 inhibitor.1 Because these patients remain intubated and mechanically ventilated after reestablishment of spontaneous circulation, administration of crushed and dissolved tablets by nasogastric tube remains the only option. Because the antiplatelet effect of clopidogrel is significantly decreased during the first 48 hours after reestablishment of spontaneous circulation,2 we hypothesized that a novel P2Y12 inhibitor, ticagrelor, which does not require metabolic activation in the liver, might result in faster and stronger platelet inhibition.
Consecutive comatose survivors of out-of-hospital cardiac arrest with reestablishment of spontaneous circulation undergoing immediate PCI receiving a periprocedural bolus of 250 to 500 mg acetylsalicylic acid (Aspegic, Sanofi-Aventis) and unfractionated heparin to target activated clotting time between 250 and 300 seconds were randomized to ticagrelor (Brilique, AstraZeneca) or clopidogrel (Plavix, Bristol-Myers Squibb) with a random table and sealed envelope system. The tablets were crushed, dissolved into 15 to 20 mL of distilled water, and injected using a nasogastric tube. Ticagrelor was administered as 180 mg loading and then 90 mg every 12 hours. Clopidogrel was given as 600 …