The effectiveness of platelet supplementation for the reversal of ticagrelor-induced inhibition of platelet aggregation: An in-vitro study.
Eur J Anaesthesiol
; 33(5): 361-7, 2016 May.
Article
em En
| MEDLINE
| ID: mdl-26351831
ABSTRACT
BACKGROUND:
Management of ticagrelor-induced bleeding is challenging, as no antidote is currently available. Platelet transfusion, usually proposed to reverse antiplatelet drugs, has been suggested to be ineffective but few data are available.OBJECTIVE:
To assess the efficacy of platelet supplementation to restore platelet aggregation inhibited by ticagrelor.DESIGN:
In vitro study.SETTING:
Blood samples were obtained from the French Blood Bank Institute.PARTICIPANTS:
Healthy blood donors.INTERVENTIONS:
Whole blood from healthy donors was spiked with ticagrelor or aspirin (used as a positive control). MAIN OUTCOMEMEASURES:
Platelet aggregation was investigated with impedance aggregometry on whole blood [expressed in ohms (V)] and light transmission aggregometry (expressed in %) on platelet-rich plasma using ADP or arachidonic acid as agonists for ticagrelor or aspirin, respectively. Platelet supplementation was defined as the addition of washed platelet suspension increasing at least 60% of whole blood platelet count.RESULTS:
Ticagrelor (3.25âmM) inhibited ADP-induced platelet aggregation compared with control either in whole blood (2 vs. 13âV, Pâ<â0.05) or in platelet-rich plasma (15 vs. 75% Pâ<â0.05). Aspirin (25âmM) inhibited arachidonic acid-induced aggregation (1 vs. 7.5âV, Pâ<â0.05 in whole blood and 5 vs. 77.5%, Pâ=â0.01 in platelet-rich plasma). Platelet supplementation completely restored arachidonic acid-induced platelet aggregation in whole blood (10 vs. 1âV, Pâ=â0.008) and platelet-rich plasma (73 vs. 5%, Pâ<â0.01) in aspirin-treated samples, whereas it failed to correct ADP-induced aggregation (2 vs. 2âV in whole blood and 13.5 vs. 15% in platelet-rich plasma, Pâ>â0.05) in ticagrelor-treated samples. We also report a case of a ticagrelor-treated patient in whom platelet transfusion failed to restore ADP-induced platelet aggregation.CONCLUSION:
Platelet supplementation restored platelet aggregation in aspirin-spiked but not in ticagrelor-spiked samples. These results do not support the use of platelet transfusion to reverse the effects of ticagrelor.
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Inibidores da Agregação Plaquetária
/
Adenosina
/
Agregação Plaquetária
/
Transfusão de Plaquetas
Limite:
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Eur J Anaesthesiol
Assunto da revista:
ANESTESIOLOGIA
Ano de publicação:
2016
Tipo de documento:
Article