1. Balancing thrombosis and bleeding after out-of-hospital cardiac arrest related to acute coronary syndrome: A literature review
- Author
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Olivier Varenne, Emmanuel Gall, Fabien Picard, Alexandre Lafont, Florence Dumas, and Alain Cariou
- Subjects
Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,Hemorrhage ,Systemic inflammation ,law.invention ,Percutaneous Coronary Intervention ,Randomized controlled trial ,law ,Internal medicine ,Antithrombotic ,medicine ,Humans ,Cardiopulmonary resuscitation ,Myocardial infarction ,Acute Coronary Syndrome ,business.industry ,Coronary Thrombosis ,Thrombosis ,General Medicine ,medicine.disease ,Circulatory system ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Out-of-Hospital Cardiac Arrest - Abstract
Summary Balance between thrombosis and bleeding is now well recognized in patients treated for acute coronary syndrome, with impact on short- and long-term prognosis, including survival. Recent data suggest that patients who are resuscitated after out-of-hospital cardiac arrest related to myocardial infarction are at an even higher risk of bleeding and thrombosis than those with uncomplicated acute coronary syndrome. Delayed enteral absorption of medication due to induced hypothermia and systemic inflammation increases thrombosis risk, whereas transfemoral access site, cardiopulmonary resuscitation manoeuvres and mechanical circulatory support devices increase bleeding risk. In addition, post-resuscitation syndrome and renal or hepatic impairment are potential risk factors for both bleeding and thrombotic complications. There are currently no randomized controlled trials comparing various P2Y12 inhibitor and/or anticoagulation strategies in the setting of out-of-hospital cardiac arrest, and current practice is largely derived from management of patients with uncomplicated acute coronary syndrome. The aim of this review is therefore to describe the bleeding and thrombosis risk factors in this specific population, and to review recent data on antithrombotic drugs in this patient subset.
- Published
- 2021