PMID- 37298012
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231106
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 12
IP  - 11
DP  - 2023 Jun 2
TI  - Outcome of Out-of-Hospital Cardiac Arrest Patients Stratified by Pre-Clinical 
      Loading with Aspirin and Heparin: A Retrospective Cohort Analysis.
LID - 10.3390/jcm12113817 [doi]
LID - 3817
AB  - Background: Out-of-hospital cardiac arrest (OHCA) has a high prevalence of 
      obstructive coronary artery disease and total coronary occlusion. Consequently, 
      these patients are frequently loaded with antiplatelets and anticoagulants before 
      hospital arrival. However, OHCA patients have multiple non-cardiac causes and 
      high susceptibility for bleeding. In brief, there is a gap in the evidence for 
      loading in OHCA patients. Objective: The current analysis stratified the outcome 
      of patients with OHCA according to pre-clinical loading. Material and Methods: In 
      a retrospective analysis of an all-comer OHCA registry, patients were stratified 
      by loading with aspirin (ASA) and unfractionated heparin (UFH). Bleeding rate, 
      survival to hospital discharge and favorable neurological outcomes were measured. 
      Results: Overall, 272 patients were included, of whom 142 were loaded. Acute 
      coronary syndrome was diagnosed in 103 patients. One-third of STEMIs were not 
      loaded. Conversely, 54% with OHCA from non-ischemic causes were pretreated. 
      Loading was associated with increased survival to hospital discharge (56.3 vs. 
      40.3%, p = 0.008) and a more favorable neurological outcome (80.7 vs. 62.6% p = 
      0.003). Prevalence of bleeding was comparable (26.8 vs. 31.5%, p = 0.740). 
      Conclusions: Pre-clinical loading did not increase bleeding rates and was 
      associated with favorable survival. Overtreatment of OHCA with non-ischemic 
      origin, but also undertreatment of STEMI-OHCA were documented. Loading without 
      definite diagnosis of sustained ischemia is debatable in the absence of reliable 
      randomized controlled data.
FAU - Macherey-Meyer, Sascha
AU  - Macherey-Meyer S
AUID- ORCID: 0000-0002-7080-6611
AD  - Clinic III for Internal Medicine, Faculty of Medicine and University Hospital 
      Cologne, University of Cologne, 50931 Cologne, Germany.
FAU - Heyne, Sebastian
AU  - Heyne S
AD  - Clinic III for Internal Medicine, Faculty of Medicine and University Hospital 
      Cologne, University of Cologne, 50931 Cologne, Germany.
FAU - Meertens, Max M
AU  - Meertens MM
AD  - Clinic III for Internal Medicine, Faculty of Medicine and University Hospital 
      Cologne, University of Cologne, 50931 Cologne, Germany.
FAU - Braumann, Simon
AU  - Braumann S
AD  - Clinic III for Internal Medicine, Faculty of Medicine and University Hospital 
      Cologne, University of Cologne, 50931 Cologne, Germany.
FAU - Niessen, Stephan F
AU  - Niessen SF
AD  - Clinic III for Internal Medicine, Faculty of Medicine and University Hospital 
      Cologne, University of Cologne, 50931 Cologne, Germany.
FAU - Baldus, Stephan
AU  - Baldus S
AD  - Clinic III for Internal Medicine, Faculty of Medicine and University Hospital 
      Cologne, University of Cologne, 50931 Cologne, Germany.
FAU - Lee, Samuel
AU  - Lee S
AD  - Clinic III for Internal Medicine, Faculty of Medicine and University Hospital 
      Cologne, University of Cologne, 50931 Cologne, Germany.
FAU - Adler, Christoph
AU  - Adler C
AD  - Clinic III for Internal Medicine, Faculty of Medicine and University Hospital 
      Cologne, University of Cologne, 50931 Cologne, Germany.
LA  - eng
PT  - Journal Article
DEP - 20230602
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC10253358
OTO - NOTNLM
OT  - NSTE-ACS
OT  - OHCA
OT  - STEMI
OT  - aspirin
OT  - heparin
COIS- The authors declare no conflict of interest.
EDAT- 2023/06/10 15:14
MHDA- 2023/06/10 15:15
PMCR- 2023/06/02
CRDT- 2023/06/10 01:10
PHST- 2023/05/02 00:00 [received]
PHST- 2023/05/19 00:00 [revised]
PHST- 2023/05/31 00:00 [accepted]
PHST- 2023/06/10 15:15 [medline]
PHST- 2023/06/10 15:14 [pubmed]
PHST- 2023/06/10 01:10 [entrez]
PHST- 2023/06/02 00:00 [pmc-release]
AID - jcm12113817 [pii]
AID - jcm-12-03817 [pii]
AID - 10.3390/jcm12113817 [doi]
PST - epublish
SO  - J Clin Med. 2023 Jun 2;12(11):3817. doi: 10.3390/jcm12113817.