Update
Out-of-hospital cardiac arrest (CA) comprises a cascade of events with no specific treatment beyond CPR but mortality as high as 95%. Up to 70% of CA patients have underlying acute myocardial infarction or pulmonary embolism. Both conditions, as well as systemic activation of coagulation associated with reperfusion after cardiac arrest, are potentially responsive to fibrinolytic therapy, as demonstrated in small trials/observational studies. This was the rationale for the TROICA trial.
1,050 patients suffering from witnessed out-of-hospital arrest of presumed cardiac origin were randomly assigned to TNK or placebo, plus standard therapy for CA. The ITT analysis showed that the addition of TNK to standard CPR did not increase the 30-day survival rate (18.2% vs. 20.2%, NS) nor the hospital admission rate (59.0% vs. 59.5%, NS).
The symptomatic intracranial haemorrhage (1% vs. 0%) and major bleeding (8.9% versus 7.4%) rates were not significantly different between groups. Possible explanations for these unexpected results: inappropriate timing of TNK administration (too early/too late); negative interactions (e.g., vasopressors, pH, etc.); and lack of adjunctive antithrombotic therapy.
[Presentation available]
Update
Out-of-hospital cardiac arrest (CA) comprises a cascade of events with no specific treatment beyond CPR but mortality as high as 95%. Up to 70% of CA patients have underlying acute myocardial infarction or pulmonary embolism. Both conditions, as well as systemic activation of coagulation associated with reperfusion after cardiac arrest, are potentially responsive to fibrinolytic therapy, as demonstrated in small trials/observational studies. This was the rationale for the TROICA trial.
1,050 patients suffering from witnessed out-of-hospital arrest of presumed cardiac origin were randomly assigned to TNK or placebo, plus standard therapy for CA. The ITT analysis showed that the addition of TNK to standard CPR did not increase the 30-day survival rate (18.2% vs. 20.2%, NS) nor the hospital admission rate (59.0% vs. 59.5%, NS).
The symptomatic intracranial haemorrhage (1% vs. 0%) and major bleeding (8.9% versus 7.4%) rates were not significantly different between groups. Possible explanations for these unexpected results: inappropriate timing of TNK administration (too early/too late); negative interactions (e.g., vasopressors, pH, etc.); and lack of adjunctive antithrombotic therapy.
[Presentation available]
Session Number : 709011
Session Title: Hotline II