Dual Antiplatelet Therapy For Shock Patients With Acute Myocardial Infarction

Prior treatment

• Contraindications of antiplatelet therapy with ticagrelor/cangrelor
  • Recent (\< 6 months) major bleeding
  • Recent (\< 1 month) major surgery/injury
  • History of intracranial bleeding
  • History of stroke/TIA
  • Known intolerance to ticagrelor/cangrelor
  • Severe impairment of hepatic function
  • Concomitant administration of strong CYP3A4 inhibitors (for example, ketoconazole, clarithromycin, nefazodone, ritonavir, and atazanavir)
• Administration of a loading dose of an oral P2Y12 inhibitor prior to admission (clopidogrel ≥ 300 mg, ticagrelor 180 mg, prasugrel 60 mg)
• Need of concomitant chronic anticoagulation therapy due to indications such as atrial fibrillation, artificial valve, thromboembolic disease, etc.

• Age over 18 years
• Acute myocardial infarction according to the definition of ESC/ACC/AHA, indicated for emergency percutaneous coronary intervention (primary PCI strategy)
• Cardiogenic shock present upon admission due to the AMI (≥ 2 of the criteria below are satisfied)
  • sBP \< 90 mmHg with the absence of hypovolemia
  • Need of vasopressor and/or inotropic therapy
  • Presence of the signs of the organ hypoperfusion - cyanosis, cold acra, disorder of consciousness, congestive heart failure
• Informed consent form signed
• Women of childbearing potential should be protected from pregnancy throughout the study (relevant for long-term use of ticagrelor). Suitable methods of contraception in this case include hormonal contraceptives, barrier methods, or complete withdrawal - as long as it is consistent with the patient's lifestyle.