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Administration of intravenous fentanyl and laboratory efficacy of new p2y12 receptor antagonists in patients with STE myocardial infarction

Session Poster Session 1

Speaker Zuzana Motovska

Event : Acute Cardiovascular Care 2015

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Antiplatelet Agents
  • Session type : Poster Session

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 ,

Antithrombotic therapy

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 ( 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.

Characteristic Fentanyl No N= 84 Fentanyl Yes N = 59 P value
Age (Mean SD) Years 61.7 (11.8) 57.5 (11.8) 0.04
Female gender 20.2% 28.8% 0.3
Hypertension 67.9% 66.1% 0.9
Diabetes mellitus 28.6% 20.3% 0.2
Current smoker 64.2% 66.1% 0.9
Hyperlipidemia 31.0% 20.3% 0.2
Chronic kidney disease 11.9% 6.8% 0.4
LVEF ≤30% 11.9% 8.6% 0.6

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