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Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI)

2021Journal article Open access
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dc.contributor.authorGorog, Diana
dc.contributor.authorPrice, Susanna
dc.contributor.authorSibbing, Dirk
dc.contributor.authorBaumbach, Andreas
dc.contributor.authorCapodanno, Davide
dc.contributor.authorGigante, Bruna
dc.contributor.authorHalvorsen, Sigrun
dc.contributor.authorHuber, Kurt
dc.contributor.authorLettino, Maddalena
dc.contributor.authorLeonardi, Sergio
dc.contributor.authorMorais, João
dc.contributor.authorRubboli, Andrea
dc.contributor.authorSiller-Matula, Jolanta M
dc.contributor.authorStorey, Robert F
dc.contributor.authorVranckx, Pascal
dc.contributor.authorRocca, Bianca
dc.date.accessioned2022-05-12T16:37:39Z
dc.date.available2022-05-12T16:37:39Z
dc.date.issued2021
dc.description.abstractTimely and effective antithrombotic therapy is critical to improving outcome, including survival, in patients with acute coronary syndrome (ACS). Achieving effective platelet inhibition and anticoagulation, with minimal risk, is particularly important in high-risk ACS patients, especially those with cardiogenic shock (CS) or those successfully resuscitated following out-of-hospital cardiac arrest (OHCA), who have a 30-50% risk of death or a recurrent ischaemic event over the subsequent 30 days. There are unique challenges to achieving effective and safe antithrombotic treatment in this cohort of patients that are not encountered in most other ACS patients. This position paper focuses on patients presenting with CS or immediately post-OHCA, of presumed ischaemic aetiology, and examines issues related to thrombosis and bleeding risk. Both the physical and pharmacological impacts of CS, namely impaired drug absorption, metabolism, altered distribution and/or excretion, associated multiorgan failure, co-morbidities and co-administered treatments such as opiates, targeted temperature management, renal replacement therapy and circulatory or left ventricular assist devices, can have major impact on the effectiveness and safety of antithrombotic drugs. Careful attention to the choice of antithrombotic agent(s), route of administration, drug-drug interactions, therapeutic drug monitoring and factors that affect drug efficacy and safety, may reduce the risk of sub- or supra-therapeutic dosing and associated adverse events. This paper provides expert opinion, based on best available evidence, and consensus statements on optimising antithrombotic therapy in these very high-risk patients, in whom minimising the risk of thrombosis and bleeding is critical to improving outcome.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationDiana A Gorog, Susanna Price, Dirk Sibbing, Andreas Baumbach, Davide Capodanno, Bruna Gigante, Sigrun Halvorsen, Kurt Huber, Maddalena Lettino, Sergio Leonardi, Joao Morais, Andrea Rubboli, Jolanta M Siller-Matula, Robert F Storey, Pascal Vranckx, Bianca Rocca, Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Heart Journal - Cardiovascular Pharmacotherapy, Volume 7, Issue 2, March 2021, Pages 125–140, https://doi.org/10.1093/ehjcvp/pvaa009pt_PT
dc.identifier.doi10.1093/ehjcvp/pvaa009pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.8/7126
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherEuropean Society of Cardiologypt_PT
dc.relation.ispartofseries2;
dc.relation.publisherversionhttps://academic.oup.com/ehjcvp/article/7/2/125/5734651?login=truept_PT
dc.subjectAntithrombotic medicationpt_PT
dc.subjectCardiogenic shockpt_PT
dc.subjectAcute coronary syndromept_PT
dc.subjectCardiac arrestpt_PT
dc.subjectAntiplateletpt_PT
dc.subjectThrombosispt_PT
dc.titleAntithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI)pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage140pt_PT
oaire.citation.startPage125pt_PT
oaire.citation.titleEuropean Heart Journal - Cardiovascular Pharmacotherapypt_PT
oaire.citation.volume7pt_PT
person.familyNameGorog
person.familyNameBaumbach
person.familyNameMorais
person.givenNameDiana
person.givenNameAndreas
person.givenNameJoão
person.identifier.ciencia-id3614-652A-118E
person.identifier.orcid0000-0002-9286-1451
person.identifier.orcid0000-0001-7707-2254
person.identifier.orcid0000-0003-3406-2878
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationc80375f9-1685-418f-adf8-b5a4b434a838
relation.isAuthorOfPublicatione0f30c59-08b7-44ae-8b8d-7d1c4717f198
relation.isAuthorOfPublication3bc0f910-a460-461f-863a-1ca701ee597f
relation.isAuthorOfPublication.latestForDiscoveryc80375f9-1685-418f-adf8-b5a4b434a838

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