{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T22:58:42Z","timestamp":1784761122521,"version":"3.55.0"},"reference-count":38,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,4,6]],"date-time":"2024-04-06T00:00:00Z","timestamp":1712361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University Medical Center Ljubljana (Slovenia)","award":["P3-0308"],"award-info":[{"award-number":["P3-0308"]}]},{"name":"Chiesi Slovenia d.d.","award":["P3-0308"],"award-info":[{"award-number":["P3-0308"]}]},{"DOI":"10.13039\/501100004329","name":"Slovenian Research Agency research program","doi-asserted-by":"publisher","award":["P3-0308"],"award-info":[{"award-number":["P3-0308"]}],"id":[{"id":"10.13039\/501100004329","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Comatose survivors of out-of-hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI) and target temperature management (TTM) are at increased risk of stent thrombosis (ST), partly due to delayed platelet inhibition even with more potent P2Y12 agents. We hypothesized that periprocedural cangrelor would induce immediate platelet inhibition, bridging the \u201cP2Y12 inhibition gap\u201d. Methods: In our pilot study, we randomized 30 comatose OHCA patients undergoing PCI and TTM (32\u201334 \u00b0C) into cangrelor and control groups. Both groups received unfractioned heparin, acetylsalicylic acid, and ticagrelor via enteral tube. The cangrelor group also received an intravenous bolus of cangrelor followed by a 4 h infusion. Platelet inhibition was measured using VerifyNow\u00ae and Multiplate\u00ae ADP at baseline and 1, 3, 5, and 8 h post PCI. Results: Patient characteristics did not differ between groups. VerifyNow\u00ae showed significantly decreased platelet reactivity with cangrelor at 1 h (30 vs. 221 PRU; p &lt; 0.001) and 3 h (24 vs. 180 PRU; p &lt; 0.001), with differences at 5 and 8 h. Similarly, the proportion of patients with high on-treatment platelet reactivity (HPR) in the cangrelor group was significantly lower at 1 h (0% vs. 67%; p &lt; 0.001) and 3 h (0% vs. 47%; p = 0.007). Multiplate\u00ae ADP was also decreased at 1 h (14 vs. 48 U; p &lt; 0.001) and 3 h (11 vs. 42 U; p = 0.001), with no difference at 5 and 8 h. The occurrence of bleeding events was similar in both groups. Conclusions: Cangrelor safely induced immediate and profound platelet inhibition. We observed no significant drug\u2013drug interaction with ticagrelor.<\/jats:p>","DOI":"10.3390\/jcm13072121","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T06:04:58Z","timestamp":1712556298000},"page":"2121","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Immediate Platelet Inhibition Strategy for Comatose Out-of-Hospital Cardiac Arrest Survivors Undergoing Percutaneous Coronary Intervention and Mild Therapeutic Hypothermia"],"prefix":"10.3390","volume":"13","author":[{"given":"Peter","family":"Kordis","sequence":"first","affiliation":[{"name":"Center for Intensive Internal Medicine, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jernej","family":"Berden","sequence":"additional","affiliation":[{"name":"Center for Intensive Internal Medicine, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursa","family":"Mikuz","sequence":"additional","affiliation":[{"name":"Center for Intensive Internal Medicine, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Noc","sequence":"additional","affiliation":[{"name":"Center for Intensive Internal Medicine, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Pr\u00fcller, F., Bis, L., Milke, O.L., Fruhwald, F., P\u00e4tzold, S., Altmanninger-Sock, S., Siller-Matula, J.M., Von Lewinski, F., Ablasser, K., and Sacherer, M. (2018). Cangrelor Induces More Potent Platelet Inhibition without Increasing Bleeding in Resuscitated Patients. J. Clin. Med., 7.","DOI":"10.3390\/jcm7110442"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.resuscitation.2017.10.019","article-title":"Early coronary angiography in patients resuscitated from out of hospital cardiac arrest without ST-segment elevation: A systematic review and meta-analysis","volume":"121","author":"Khan","year":"2017","journal-title":"Resuscitation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e001593","DOI":"10.1161\/CIRCINTERVENTIONS.114.001593","article-title":"Morphine is associated with a delayed activity of oral antiplatelet agents in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention","volume":"8","author":"Parodi","year":"2014","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1161\/CIRCULATIONAHA.116.024872","article-title":"Ticagrelor Versus Clopidogrel in Comatose Survivors of Out-of-Hospital Cardiac Arrest Undergoing Percutaneous Coronary Intervention and Hypothermia: A Randomized Study","volume":"134","author":"Steblovnik","year":"2016","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4244\/EIJV10I1A7","article-title":"Invasive coronary treatment strategies for out-of-hospital cardiac arrest: A consensus statement from the European association for percutaneous cardiovascular interventions (EAPCI)\/stent for life (SFL) groups","volume":"10","author":"Noc","year":"2014","journal-title":"EuroIntervention"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1002\/ccd.28455","article-title":"Technical consideration in acute myocardial infarction with cardiogenic shock: A review of antithrombotic and PCI therapies","volume":"95","author":"Zeitouni","year":"2020","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1161\/CIRCINTERVENTIONS.111.967083","article-title":"Stent thrombosis with everolimus-eluting stents: Meta-analysis of comparative randomized controlled trials","volume":"5","author":"Palmerini","year":"2012","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.jacc.2013.09.028","article-title":"Is therapeutic hypothermia a risk factor for stent thrombosis?","volume":"63","author":"Rosillo","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.resuscitation.2014.02.013","article-title":"Stent thrombosis: An increased adverse event after angioplasty following resuscitated cardiac arrest","volume":"85","author":"Joffre","year":"2014","journal-title":"Resuscitation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.resuscitation.2015.11.006","article-title":"Stent thrombosis after primary percutaneous coronary intervention in comatose survivors of out-of-hospital cardiac arrest: Are the new P2Y12 inhibitors really more effective than clopidogrel?","volume":"98","author":"Gouffran","year":"2016","journal-title":"Resuscitation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/j.jacc.2012.10.029","article-title":"Hypothermia in acute coronary syndrome: Brain salvage versus stent thrombosis?","volume":"61","author":"Penela","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"740","DOI":"10.4244\/EIJ-D-22-00336","article-title":"Timing and predictors of definite stent thrombosis in comatose survivors of out-of-hospital cardiac arrest undergoing percutaneous coronary intervention and therapeutic hypothermia (ST-OHCA study)","volume":"18","author":"Rauber","year":"2022","journal-title":"EuroIntervention"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3559","DOI":"10.1177\/0300060519861469","article-title":"Effect of hypothermia on haemostasis and bleeding risk: A narrative review","volume":"47","author":"Kander","year":"2019","journal-title":"J. Int. Med. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1056\/NEJMoa1310519","article-title":"Targeted temperature management at 33 \u00b0C versus 36 \u00b0C after cardiac arrest","volume":"369","author":"Nielsen","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.resuscitation.2014.02.004","article-title":"High rates of prasugrel and ticagrelor non-responder in patients treated with therapeutic hypothermia after cardiac arrest","volume":"85","author":"Ibrahim","year":"2014","journal-title":"Resuscitation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1161\/hc2901.093500","article-title":"Pharmacodynamics and pharmacokinetics of eptifibatide in patients with acute coronary syndromes: Prospective analysis from PURSUIT","volume":"104","author":"Tardiff","year":"2001","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4717","DOI":"10.1002\/ehf2.13643","article-title":"Antithrombotic and anticoagulation therapies in cardiogenic shock: A critical review of the published literature","volume":"8","author":"Radu","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1093\/ehjcvp\/pvaa009","article-title":"Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: A joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI)","volume":"7","author":"Gorog","year":"2021","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1007\/s40265-015-0445-3","article-title":"Cangrelor: A Review in Percutaneous Coronary Intervention","volume":"75","author":"Keating","year":"2015","journal-title":"Drugs"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1001\/jamacardio.2016.4556","article-title":"Evaluation of Ischemic and Bleeding Risks Associated With 2 Parenteral Antiplatelet Strategies Comparing Cangrelor With Glycoprotein IIb\/IIIa Inhibitors: An Exploratory Analysis From the CHAMPION Trials","volume":"2","author":"Vaduganathan","year":"2017","journal-title":"JAMA Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.resuscitation.2018.06.032","article-title":"Optimal platelet inhibition with cangrelor in comatose survivors of out-of-hospital cardiac arrest undergoing primary percutaneous coronary intervention","volume":"130","author":"Fiore","year":"2018","journal-title":"Resuscitation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1161\/CIRCULATIONAHA.118.038317","article-title":"Platelet Inhibition With Cangrelor and Crushed Ticagrelor in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention","volume":"139","author":"Franchi","year":"2019","journal-title":"Circulation"},{"key":"ref_24","first-page":"1269","article-title":"Cangrelor for comatose survivors of out-of-hospital cardiac arrest undergoing percutaneous coronary intervention: The CANGRELOR-OHCA study","volume":"18","author":"Kordis","year":"2023","journal-title":"EuroIntervention"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1016\/j.resuscitation.2014.06.028","article-title":"Impact of intensified postresuscitation treatment on outcome of comatose survivors of out-of-hospital cardiac arrest according to initial rhythm","volume":"85","author":"Kocjancic","year":"2014","journal-title":"Resuscitation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s00134-021-06368-4","article-title":"European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: Post-resuscitation care","volume":"47","author":"Nolan","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1016\/j.jacc.2013.07.101","article-title":"Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding","volume":"62","author":"Tantry","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials: A consensus report from the Bleeding Academic Research Consortium","volume":"123","author":"Mehran","year":"2011","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1177\/1074248417728287","article-title":"Impact of Test Conditions on ADP-Induced Platelet Function Results With the Multiplate Assay: Is Further Standardization Required?","volume":"23","author":"Merkely","year":"2018","journal-title":"J. Cardiovasc. Pharmacol. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/MCA.0000000000000311","article-title":"Transition strategies from cangrelor to oral platelet P2Y12 receptor antagonists","volume":"27","author":"Schneider","year":"2016","journal-title":"Coron. Artery Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2528","DOI":"10.1016\/j.jcin.2023.08.009","article-title":"Switching From Cangrelor to Prasugrel in Patients Undergoing Percutaneous Coronary Intervention: The Switching Antiplatelet-6 (SWAP-6) Study","volume":"16","author":"Franchi","year":"2023","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1161\/CIRCULATIONAHA.120.046928","article-title":"Cangrelor, Tirofiban, and Chewed or Standard Prasugrel Regimens in Patients With ST-Segment-Elevation Myocardial Infarction: Primary Results of the FABOLUS-FASTER Trial","volume":"142","author":"Gargiulo","year":"2020","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Buchtele, N., Herkner, H., Sch\u00f6rgenhofer, C., Merrelaar, A., Laggner, R., Gelbenegger, G., Spiel, A.O., Domanovits, H., Lang, I., and Jilma, B. (2020). High Platelet Reactivity after Transition from Cangrelor to Ticagrelor in Hypothermic Cardiac Arrest Survivors with ST-Segment Elevation Myocardial Infarction. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020583"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Bla\u0161ko, P., Samo\u0161, M., Bolek, T., Stan\u010diakov\u00e1, L., \u0160kor\u0148ov\u00e1, I., P\u00e9\u010d, M.J., Jurica, J., Sta\u0161ko, J., and Mok\u00e1\u0148, M. (2022). Resistance on the Latest Oral and Intravenous P2Y12 ADP Receptor Blockers in Patients with Acute Coronary Syndromes: Fact or Myth?. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237211"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e010390","DOI":"10.1161\/CIRCINTERVENTIONS.120.010390","article-title":"Ischemic Events Occur Early in Patients Undergoing Percutaneous Coronary Intervention and Are Reduced With Cangrelor: Findings From CHAMPION PHOENIX","volume":"15","author":"Cavender","year":"2022","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_36","first-page":"3111840","article-title":"Dual Antiplatelet Therapy in Patients Aged 75 Years and Older with Coronary Artery Disease: A Meta-Analysis and Systematic Review","volume":"2022","author":"Lacy","year":"2022","journal-title":"J. Interv. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ijcard.2022.01.019","article-title":"Net clinical benefit of different strategies of dual antiplatelet therapy in elderly patients: Data from the praise registry","volume":"353","author":"Elia","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.resuscitation.2016.06.031","article-title":"Safety of glycoprotein IIb\/IIIa inhibitors in patients under therapeutic hypothermia admitted for an acute coronary syndrome","volume":"106","author":"Freixa","year":"2016","journal-title":"Resuscitation"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/2121\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:24:02Z","timestamp":1760106242000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/2121"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,6]]},"references-count":38,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jcm13072121"],"URL":"https:\/\/doi.org\/10.3390\/jcm13072121","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,6]]}}}