Article

Journal of Cardiovascular Translational Research

, Volume 7, Issue 1, pp 39-46

First online:

Impact of Mild Hypothermia on Platelet Responsiveness to Aspirin and Clopidogrel: an In Vitro Pharmacodynamic Investigation

  • José Luis FerreiroAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona Email author 
  • , José Carlos Sánchez-SaladoAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
  • , Montserrat GracidaAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
  • , Ana Lucrecia MarcanoAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
  • , Gerard RouraAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
  • , Albert ArizaAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
  • , Josep Gómez-LaraAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
  • , Victoria LorenteAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
  • , Rafael RomagueraAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
    • , Sílvia HomsAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
    • , Guillermo Sánchez-ElviraAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
    • , Luis TeruelAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
    • , Kristian RiveraAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
    • , Silvia Gabriela SosaAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
    • , Joan Antoni Gómez-HospitalAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona
    • , Dominick J. AngiolilloAffiliated withUniversity of Florida College of Medicine-Jacksonville
    • , Ángel CequierAffiliated withHeart Diseases Institute, Bellvitge University Hospital—IDIBELL, University of Barcelona

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Abstract

The combination of percutaneous coronary intervention (PCI) and therapeutic hypothermia in comatose patients after cardiac arrest due to an acute coronary syndrome has been reported to be safe and effective. However, recent investigations suggest that hypothermia may be associated with impaired response to clopidogrel and greater risk of thrombotic complications after PCI. This investigation aimed to evaluate the effect of hypothermia on the pharmacodynamic response of aspirin and clopidogrel in patients (n = 20) with ST elevation myocardial infarction undergoing primary PCI. Higher platelet reactivity (ADP stimulus) was observed in samples incubated at 33 °C compared with those at 37 °C (multiple electrode aggregometry, 235.2 ± 31.4 AU×min vs. 181.9 ± 30.2 AU×min, p < 0.001; VerifyNow P2Y12, 172.9 ± 20.3 PRU vs. 151.0 ± 19.3 PRU, p = 0.004). Numerically greater rates of clopidogrel poor responsiveness were also observed at 33 °C. No differences were seen in aspirin responsiveness. In conclusion, mild hypothermia was associated with reduced clopidogrel-mediated platelet inhibition with no impact on aspirin effects.

Clinical relevance: Mild therapeutic hypothermia is associated with impaired response to clopidogrel therapy, which might contribute to increase the risk of thrombotic events in ACS comatose patients undergoing PCI.

Keywords

Therapeutic hypothermia Antiplatelet therapy ST elevation myocardial infarction