ArticleEuropean journal of clinical pharmacology2013
Impaired bioavailability and antiplatelet effect of high-dose clopidogrel in patients after cardiopulmonary resuscitation (CPR).
Article in European journal of clinical pharmacology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02224274 (Comparison of Antiplatelet Therapy With Clopidogrel and Ticagrelor in Patients After Cardiac Arrest Treated With Therapeutic Hypothermia), which is not on this map. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Comparison of Antiplatelet Therapy With Clopidogrel and Ticagrelor in Patients After Cardiac Arrest Treated With Therapeutic Hypothermia
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Cangrelor in critically ill patients with cardiogenic shock or post-cardiac arrest undergoing percutaneous coronary intervention: a systematic review and meta-analysis.Critical care (London, England) · 2025Pooled it
- The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society.Neurocritical care · 2017Pooled it
- Clopidogrel in Critically Ill Patients.Clinical pharmacology and therapeutics · 2018Trial
- Current and Future Roles of Glycoprotein IIb-IIIa Inhibitors in Primary Angioplasty for ST-Segment Elevation Myocardial Infarction.Biomedicines · 2024Review
- Cangrelor - Expanding therapeutic options in patients with acute coronary syndrome.Cardiology journal · 2024Article
- Bioavailability of Orally Administered Drugs in Critically Ill Patients.Journal of pharmacy practice · 2023Article
- Use of cangrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Study design and interim analysis of the ARCANGELO study.Clinical cardiology · 2022Article
- One-Year Outcome of Glycoprotein IIb/IIIa Inhibitor Therapy in Patients with Myocardial Infarction-Related Cardiogenic Shock.Journal of clinical medicine · 2021Article
- COVID-19 Infection and High Intracoronary Thrombus Burden.Cardiovascular revascularization medicine : including molecular interventions · 2021Review
- Cangrelor Use in Routine Practice: A Two-Center Experience.Journal of clinical medicine · 2021Article
- Feasibility and safety of cangrelor in patients with suboptimal P2YBMC cardiovascular disorders · 2021Observational
- The influence of acute coronary syndrome on levels of clopidogrel active metabolite and platelet inhibition in patients with and without CYP2C19*2(681 G>A), *3(636 G>A) and ABCB1(C3435C> T) gene polymorphisms.Postepy w kardiologii interwencyjnej = Advances in interventional cardiology · 2021Article
- Erythropoietin therapy after out-of-hospital cardiac arrest: A systematic review and meta-analysis.World journal of cardiology · 2017Article
- Role of New Antiplatelet Drugs on Cardiovascular Disease: Update on Cangrelor.Current atherosclerosis reports · 2016Review
- Antiplatelet efficacy of P2Y12 inhibitors (prasugrel, ticagrelor, clopidogrel) in patients treated with mild therapeutic hypothermia after cardiac arrest due to acute myocardial infarction.Journal of thrombosis and thrombolysis · 2016Observational
- Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management.Interventional cardiology (London, England) · 2016Article
- Anti-platelet Therapy Resistance - Concept, Mechanisms and Platelet Function Tests in Intensive Care Facilities.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2016Article
- Review
- Platelet aggregation and clot formation in comatose survivors of cardiac arrest treated with induced hypothermia and dual platelet inhibition with aspirin and ticagrelor; a prospective observational study.Critical care (London, England) · 2014Observational
- Clopidogrel does not work following cardiopulmonary resuscitation.European journal of clinical pharmacology · 2013Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeBioavailability of clopidogrel in the form of crushed tablets administered via nasogastric tube (NGT) has not been established in patients after cardiopulmonary resuscitation. Therefore, we performed a study comparing pharmacokinetic and pharmacodynamic response to high loading dose of clopidogrel in critically ill patients after cardiopulmonary resuscitation (CPR) with patients scheduled for elective coronary angiography with stent implantation.
methodsIn the NGT group (nine patients, after cardiopulmonary resuscitation, mechanically ventilated, therapeutic hypothermia), clopidogrel was administered in the form of crushed tablets via NGT. Ten patients undergoing elective coronary artery stenting took clopidogrel per os (po) in the form of intact tablets. Pharmacokinetics of clopidogrel was measured with high-performance liquid chromatography (HPLC) before and at 0.5, 1, 6, 12, 24 h after administration of a loading dose of 600 mg. In five patients in each group, antiplatelet effect was measured with thrombelastography (TEG; Platelet Mapping) before and 24 h after administration.
resultsThe carboxylic acid metabolite of clopidogrel was detected in all patients in the po group. In eight patients, the maximum concentration was measured in the range of 0.5-1 h after the initial dose. In four patients in the of NGT group, the carboxylic acid metabolite of clopidogrel was undetectable and in the remaining patients was significantly delayed (peak values at 12 h). All patients in the po group reached clinically relevant (>50 %) inhibition of thrombocyte adenosine diphosphate (ADP) receptor after 24 h compared with only two in the NGT group (p = 0.012). There was a close correlation between peak of inactive clopidogrel metabolite plasmatic concentration and inhibition of the ADP receptor (r = 0.79; p < 0.001).
conclusionThe bioavailability of clopidogrel in critically ill patients after cardiopulmonary resuscitation is significantly impaired compared with stable patients. Therefore, other drugs, preferentially administered intravenously, should be considered.
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