Effect of targeted temperature management on platelet function in patients with out-of-hospital cardiac arrest due to acute myocardial infarction

Introduction: Targeted temperature management (TTM) is recommended in the European Resuscitation Council Guidelines for Post-resuscitation Care.1 However, previous studies report controversial results on the effect of TTM on platelet function (PF) in patients on dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors. Hypothesis: To assess if the effect of DAPT on platelet inhibition in patients undergoing TTM for out-of-hospital cardiac arrest (OHCA) is reduced compared to patients on the same therapy not undergoing this procedure. Patients and Methods: Clinical characteristics and PF were analyzed in 56 consecutive patients admitted to the Department of Cardiology at the University Hospital Centre between January 2012 and January 2019 under the diagnosis of acute myocardial infarction (AMI). Out of these 56 patients, 17 underwent TTM to 34°C (Intervention group) while the other 39 did not (Control group). Both groups received the loading dose of DAPT. We analyzed residual PF using the Multiplate® PF analyzer ADP test. Platelet function tests (PFT) were performed 18-24 hours after therapy initiation in both groups and 18-24 hours after return to normal body temperature of 36.5° C in the TTM group. The control group had an average temperature of 36.5° C at the time of the PFT. Results: There were 39 patients with a mean (SD) age of 63.2 (9.9) years in the Control group and 17 patients with a mean (SD) age of 58.6 (8.2) in the Interventional group. There were no significant differences in the baseline parameters between the groups (history of IHD, hyperlipidemia, diabetes mellitus, smoking, gender, prior medical therapy, current medical therapy). At the first time point (18-24 hours after initiating therapy) the intervention group had a significantly higher residual PF when compared to the control group (31.5 U vs 17.9 U; p<0.05). This difference is no longer present 18-24 hours after return to normothermia (p=0.2) (Figure 1). Conclusion: Our study shows that TTM decreases the effect of DAPT on PF in patients with AMI undergoing TTM for OHCA. This is in line with the findings published by Uminska et al2 who showed that TTM severely decreases the bioavailability of P2Y12 inhibitors in this group of patients. These findings indicate that patients with AMI who experienced an OHCA undergoing TTM could have an impaired response to standard DAPT

Does the use of high dose atorvastatin in combination with dual antiplatelet therapy modify residual platelet activity in patients with acute coronary syndrome?

Introduction: Dual antiplatelet therapy (DAPT) represents one of the pillars in the treatment of acute coronary syndromes (ACS)1. In the past the most commonly used combination of antiplatelet drugs has been acetylsalicylic acid (ASA) and clopidogrel. Clopidogrel had a high incidence rate of high residual platelet reactivity and has, in recent years, been replaced with ticagrelor, a more potent platelet inhibitor with a more uniformed response across the patient population. The effect of high dose atorvastatin on platelet reactivity mediated by ASA and clopidogrel is well researched, however no studies have been published analyzing this effect when clopidogrel is substituted with ticagrelor. Purpose: To investigate if high dose atorvastatin modifies PF mediated by DAPT in patient with ACS as measured by platelet function tests (PFTs). Patients and Methods: We analyzed clinical characteristics and PF in patients presenting with ACS at the Department of Cardiovascular Diseases at the University Hospital Centre Zagreb from December 2015 to February 2018. Primary endpoint was PF after treatment with DAPT and/or high dose atorvastatin. We analyzed PF using the Multiplate platelet function analyzer. PFTs were performed 18-24 hours after therapy initiation. None of the patients were taking statins before the index event. Results: There were 35 patients with a mean (SD) age of 61.6 (12.2) years in the atorvastatin group and 29 patients with a mean (SD) of 62.6 (9.6) years in the no-atorvastatin group. Both groups were identical in all the baseline parameters except history of hyperlipidemia (34.5% vs 65.7%, P=0.023). There were no significant differences between the two groups in PF analyzed with PFTs (Figure 1). The difference in residual platelet reactivity remained non-significant even after adjusting for sex, age and hyperlipidemia as the only co-variate that was significantly different between the group (P=0.432). Conclusion: In this pilot study on a limited sample we found no difference in residual PF in patients on DAPT weather they are on treatment with high dose atorvastatin or not. These results show that the pleiotropic effects of atorvastatin on platelet reactivity are not significant in patients taking DAPT with ticagrelor and ASA. Acknowledgement: This pilot study was funded by Croatian Science Foundation

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity—GoPA! 2015 and 2020 Surveys

Background: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. Methods: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. Results: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world’s population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world’s population live in countries where PA promotion capacity should be significantly improved. Conclusion: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion

Korozijska otpornost zavarenih spojeva od dupleks nehrđajućih čelika

Proizvodnja konstrukcija i postrojenja od dupleks nehrđajućeg čelika zahtjeva posebnu pažnju u svim fazama proizvodnog procesa, od skladištenja, rukovanja materijalom, zavarivanja i naknadne obrade zavarenog spoja, a kako bi se postigao kvalitetan zavareni spoj i osigurala dugotrajna korozijska postojanost konstrukcije. Dupleks nehrđajući čelik ima dvofaznu austenitno-feritnu mikrostrukturu, u približnom omjeru 50:50, koja je osjetljiva na unos topline prilikom zavarivanja zbog moguće pojave feritizacije, tj. pojave povećanog udjela ferita (i do 80%) u području zone utjecaja topline (ZUT) i narušavanja mehaničkih i korozijskih svojstva materijala. Također, neprimjeren rad s takvim materijalima u kloridnim okolišima može rezultirati oštećivanjem pasivnog filma i pojavom lokalnih korozijskih oštećenja. U radu su provedena ispitivanja strukturnih svojstava sučeljenog zavarenog spoja na uzorcima od dupleks nehrđajućeg čelika oznake EN 1.4462 (2205) pripremljenih u Brodogradilištu Uljanik u Puli, te zavarenog spoja austenitnog svornjaka i osnovnog materijala od dupleks nehrđajućeg čelika pripremljenih u tvrtki Metalvar iz Zagreba. Posebno je ispitan utjecaj naknadne kemijske obrade zavarenog spoja na otpornost na rupičastu koroziju na sobnoj i povišenoj temperaturi

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity—GoPA! 2015 and 2020 Surveys

Background: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. Methods: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. Results: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world’s population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world’s population live in countries where PA promotion capacity should be significantly improved. Conclusion: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.</jats:p