Delayed Angioedema From Ticagrelor Initiation: A Life Threatening Reaction

Mathis, Emily; Pearce, Brandon; Mundell, Jennifer

doi:10.1016/s0735-1097(21)04292-3

Cited by 2 publications

(2 citation statements)

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“…The incidence of drug-induced angioedema is estimated to be less than 1%, and it most commonly occurs in association with ACE inhibitors [ 7 ]. According to the U.S. National Library of Medicine (NLM), hypersensitivity reactions to ticagrelor are uncommon, and 34 cases were reported to have an adverse effect with rashes by the U.S. Food and Drug Administration [ 8 ]. Ticagrelor-induced angioedema, which has been documented in two out of the 34 reported cases, is even rarer [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ticagrelor-induced angioedema, which has been documented in two out of the 34 reported cases, is even rarer [9]. However, in the cases collected by NLM and additional instances reported throughout the literature, the onset of these reactions is immediate, usually occurring within hours of exposure [7][8][9][10][11][12][13][14]. The most delayed reaction reported in the literature occurred approximately 36 hours after the first dose of ticagrelor [15].…”

Section: Discussionmentioning

confidence: 99%

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Ticagrelor: A Rare, Delayed Case of Angioedema

Walia¹,

Alam²,

Prenatt³

et al. 2023

Cureus

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Dual antiplatelet therapy (DAPT) with P2Y12 receptor inhibitors in conjunction with aspirin is the gold standard treatment for acute coronary syndrome (ACS) and to prevent stent thrombosis after percutaneous coronary intervention (PCI). While there have been reported allergic effects-particularly angioedema-linked to clopidogrel there is limited data on hypersensitivity reactions to ticagrelor. Here, we discuss a case of delayed-onset ticagrelor-induced angioedema in a patient, three weeks following initiation of DAPT with aspirin and ticagrelor status post-PCI with DES placement. The patient presented with acute onset tongue swelling and was successfully treated with epinephrine, steroids, and antihistamine. The C1 esterase inhibitor and tryptase levels were within normal limits. Ticagrelor was discontinued and the patient was transitioned to prasugrel for DAPT, without recurrence of symptoms. Given the few cases reported involving ticagrelor-induced angioedema, and the even rare, delayed onset cases such as those described above, it is imperative that clinicians be made aware of this adverse effect and its management.

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Section: Discussionmentioning

confidence: 99%