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Administration of intravenous fentanyl and laboratory efficacy of new p2y12 receptor antagonists in patients with STE myocardial infarction
Authors : Z Motovska (Prague,CZ), J Knot (Prague,CZ), M Ondrakova (Prague,CZ), F Bednar (Prague,CZ), J Ulman (Prague,CZ), M Maly (Prague,CZ), P Widimsky (Prague,CZ)
Z Motovska1
,
J Knot1
,
M Ondrakova1
,
F Bednar1
,
J Ulman2
,
M Maly3
,
P Widimsky1
,
1Charles University Prague, 3rd Faculty of Medicine, Faculty Hospital Kralovske Vinohrady - Prague - Czech Republic
,
2Faculty Hospital Kralovske Vinohrady - Prague - Czech Republic
,
3National Institute of Public Health - Prague - Czech Republic
,
Citation:
European Heart Journal: Acute Cardiovascular Care
(
2015
)
4
(
Supplement 5
),
S21
Aim. Presented study aimed to determine the influence of intravenous fentanyl, a synthetic opiate analgesic, on laboratory efficacy of new P2Y12 antagonists in patients with STE myocardial infarction treated with primary PCI. Methods . Study population consisted of 143 patients with obtainable information about (non) administration of fentanyl who were participating in the LAPCOR registry (ClinicalTrials.gov NCT02264912). P2Y12 antagonist efficacy was measured by VASP phosphorylation 24±4 hours after a loading dose of prasugrel (60 mg, N=80), or ticagrelor (180 mg, N=63) and expressed by platelet reactivity index (PRI). HTPR was defined as PRI ≥ 50%. Results: Residual platelet reactivity in patients initiated on ticagrelor was (median, min to max) 14.3 (0.1 to 44.9)% in patients (N=29) receiving fentanyl, and 14.9 (0.3 to 46.2) % in patients (N=34) who did not (p=0.7). No HPTR was detected in ticagrelor-treated patients, irrespective of fentanyl administration. Residual platelet reactivity in patients initiated on prasugrel was (median, min to max) 13.3 (0.0 to 84.6)% in patients (N=30) receiving fentanyl, and 10.0 (0.3 to 56.4)% in patients (N=50) without fentanyl administration (p=0.13). Logistic regression showed that fentanyl administration did not significantly influence the probability of HTPR in prasugrel-treated patients (Odds Ratio (95% C.I.) 3.7 (0.6, 21.5), p=0.13). Controlling for baseline characteristics did not influence presented results. Conclusion . Administration of fentanyl did not significantly diminish the maximal inhibition of platelet aggregation after a loading dose of new P2Y12 antagonists.
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